Resonant voice therapy (RVT) is an established method of treating voice disorders. For more information, see ASHA’s Practice Portal page on Voice Disorders.
Encourage patients to sense vibration or tickling sensation in front of their face, with an emphasis on easy phonation and pronunciation.
Resonant techniques such as vocal function exercises, lip trills, diaphragmatic breathing exercises, neck massage and laryngeal massage as well as vocalizing into straws can help enhance voice outcomes and produce successful voice outcomes.
Oral Sensations
Resonant voice therapy emphasizes vibration in one’s mouth and nasal cavity during phonation to develop a stronger and cleaner voice with less impact between vocal folds. Oral sensations include easy phonations and sensory processing beginning with basic speech gestures before transitioning into conversational speech, as well as forward focus and kinesthetic awareness of one’s own voice; Katherine Verdolini Abbott created the Y-Buzz technique as one way of doing this type of therapy.
Resonance Voice Therapy is an effective therapy for various disorders affecting the voice, including muscle tension dysphonia (MTD). MTD causes laryngeal muscles to tighten and restrict airflow resulting in hoarseness, strain or loss of pitch; Resonance Voice Therapy also treats granulomas that form due to irritation or inflammation of tissue in the vocal cords.
A comprehensive review published in 2017 demonstrated that resonant voice therapy significantly enhances both voice quality and efficiency, as measured by changes in auditory perceptual judgments, videostroboscopic examinations, acoustic measurements and functional measurements both before and after therapy.
Improvements in voicing of an individual are typically the result of improved vocal fold closure, reduced breathiness and less strain on their vocal folds. Furthermore, resonant voice techniques maximize resonance to increase power of one’s voice while increasing overall stamina of their singing voice.
Vocal placement exercises and humming exercises allow individuals to explore the vibratory feeling in their lips, mouth, and nose. Resonance Shaping techniques assist SLPs in helping individuals adjust tongue posture, lip tension, mouth configuration and throat configuration in order to optimize resonance; gentle onset techniques encourage individuals to initiate sound gradually without forcefully striking vocal folds when initiating sound; all these strategies come together to enhance both quality and ease of daily communication; hence why resonant voice therapy has become such an integral component of managing dysphonia management options.
Easy Phonation
Use of plastic or reusable straws found in your kitchen can reduce vocal strain during speech production and can help improve voice quality, particularly among individuals who engage in frequent throat clearing. Straw phonation is one of the primary components of resonant voice therapy, an evidence-based approach for treating voice disorders in both children and adults. This therapy emphasizes oral sensations, effortless phonation, and sensory awareness to treat these voice conditions effectively. At first, this means sensing these sensations through basic speech gestures (such as ma, me and moo) before progressing through sentence level and conversational production. The goal is to reach for the strongest, smoothest and clearest voice possible with minimal effort or impact between vocal cords.
Speech-language pathologists frequently utilize resonant voice therapy alongside other approaches for treating voice disorders in order to maximize benefits and minimize negative side effects on the voice. Such techniques include flow phonation, Smith accent technique, Lee Silverman Voice Treatment LOUD (designed specifically for Parkinson’s disease), and expiratory muscle strength training.
Vocal fold vibration is produced through interaction among airflow, vocal cords and the thyrohyoid space. Lowering tension and increasing ease with which vocal folds vibrate is beneficial in terms of minimizing injury, inflammation, swelling and fatigue as well as increasing intelligibility and intelligibility.
Hard attack is a vocal fold condition caused by excess tension and difficulty producing vowels, where vocal folds come together with too much force at the beginning of words or syllables – usually at their beginning – leading to an audible “thunk,” most noticeably in phrases like “Annie ate an apple.” To reduce hard attack’s negative impacts on vowel production and its sound production, goal should be easy onset – which involves soft contact between vocal folds.
Ingo Titze developed an easy phonation exercise known as straw phonation that uses a semi-occluded vocal tract. This form of exercise can be beneficial in managing voice nodules, polyps, overuse patterns and vocal overactivity. Click HERE for more information and YouTube video footage of it in action!
Forward Focus
Resonant voice therapy aims to create an oral vibration sensation continuum and easy phonation, beginning with basic speech productions and progressing to conversational speech. The therapy works by targeting the glottal adduction/opening mechanism to produce high amplitude vibration with minimal impact stress between vocal folds; this reduces force requirements required by patients when speaking, aiding many disorders like muscle tension dysphonia as well as vocal cord granulomas (Kao, 2019).
Resonant voice therapy is an ideal choice for children. Behavioral approaches can easily be implemented with children and can increase adherence when they demonstrate physical benefits such as decreased pain or effort with speaking. Diaphragmatic breathing, resonant voice therapy and vocal function exercises may all be used with children, although modifications should always be made depending on their level of understanding and participation within treatment sessions. Children suffering from voice disorders tend to have caregivers fill out GFI forms on them more frequently as well as being more worried about symptoms which could impact how many sessions will be required in order for them to recover completely.
Teaching Resonant Voice Therapy to children, it is vitally important that they understand the significance of following proper vocal hygiene routines at home in order to maintain healthy and strong voices for years. A handout on voice hygiene education as well as practicing with vocal functions exercises and Resonant Voice Therapy at home will assist this endeavor.
Forward Focus is a user-controlled feature available in Custom Sound 5.1 for implant recipients 12 years or older, designed to offer benefits in noisy environments for those able to actively face the person they’re communicating with and minimize distracting noise behind them. However, it should only be activated for those able to accurately assess sound quality as they move between environments or change settings.
Sensory Awareness
Resonant voice therapy focuses on the vibrations of the hard palate, alveolar ridge and nasal cavity. Kinesthetic awareness of vocal fold vibration during phonation helps develop holistic and efficient power in voice with flexibility; additionally it promotes forward focus and easy phonation (for more on this subject please see ASHA’s Practice Portal page on Voice Disorders).
Resonant voice therapy aims to produce the strongest, cleanest possible voice with minimum effort or impact between vocal folds. A 2017 systematic review demonstrated that this form of treatment improves quality and efficiency in speech production for its participants; particularly beneficial to those suffering from muscle tension dysphonia (Gartner-Schmidt 2020).
Some techniques employed in resonant voice therapy involve flow phonation and sensory processing, which enable patients to use all parts of their vocal tract. Flow phonation promotes smooth speaking without excessive force required; it may help reduce throat tightness; sensory processing allows a patient to detect unvoiced versus voiced sounds for reduced aphonia as well as increasing ease in switching pitches between low to high pitches as well as treating stuttering/apraxia (please refer to ASHA Practice Portal page for further details).
An alternative approach is Lessac-Madsen Resonant Voice Therapy (LMRVT), developed by Kathrine Verdolini Abbott and Joseph Stemple’s Resonant Voice Therapy. Both of these approaches are evidence-based; numerous studies have proven their efficacy at treating various voice disorders (see ASHA’s Practice Portal page on Voice Disorders for more).
Resonant voice therapy does not treat throat pain or hoarseness; for those experiencing these issues, speech pathologists may utilize other forms of treatment, including palatal repositioning and laryngeal injections. Due to the complexity of one’s vocal physiology, it may be hard to address all potential sources of weakness in one’s voice; thus the best way to strengthen and enhance its quality and strength is being aware of ones’ vocal habits, taking proper care with it, exercising regularly, and paying close attention when taking note of their voice habits as this will improve its strength and quality significantly.
