Resonant voice therapy focuses on creating balanced oral-nasal resonance for easy phonation. It begins with humming and gradually moves on to vocalizing words, phrases, and sentences.
SLPs can play an essential role in screening, assessing, diagnosing, treating and managing resonance disorders in individuals. Furthermore, they collaborate with craniofacial teams and cleft teams in identifying their source.
1. Vocal Quality
Voice quality refers to how well your vocal folds vibrate when producing speech, creating full sounds with minimal effort and leaving listeners with an engaging, rich experience.
Genetics, voice usage and voice habits all play a part in your vocal quality, while your diet, stress levels and emotional issues such as depression or anxiety also play an integral role. Bad vocal habits that negatively impact tone include using too much glottal fry or nasalizing consonants excessively. Your overall vocal health depends heavily on other factors as well, including diet, stress levels and emotional issues such as depression or anxiety.
Resonance disorders typically stem from physical abnormalities in your larynx, neck or throat that interfere with how your vocal folds vibrate (see ASHA’s Practice Portal page on Craniofacial Abnormalities for more details). Speech therapy may help adjust these structures in order to enhance voice quality; however it’s difficult to treat underlying causes such as genetics or illness or injury.
SLPs may help children suffering from hypernasal resonance by training articulation patterns and increasing phonatory resistance (for more information, see ASHA’s Practice Portal page on Treatment of Cleft Lip and Palate).
Exercise that enhances vibratory sensations around your lips, nose, cheek, teeth, and alveolar ridge is another effective way to strengthen the quality of your voice. Trills, voicing into a drinking straw or humming are examples of such exercises which encourage natural and resonant phonation patterns that are considered easier and less fatiguing than hypernasal speech’s harder, breathier phonation pattern.
Rating the severity of a pathological voice for qualities like vocal intensity, hoarseness, roughness, breathiness or resonant tone is a complex endeavor due to its variable nature; such qualities vary over time according to phonemic complexity, pitch and effort in speech production. Multiple linear regression analyses have been employed to predict these features in normal voices as well as those suffering from various vocal disorders; yet no single measure exists that reliably ranks these attributes against one another.
2. Vocal Health
Resonant voice therapy aims to improve vocal health by relieving tension, strengthening closure of vocal cords and encouraging balanced vibration of vocal folds during easy phonation. This reduces wear-and-tear symptoms like hoarseness, breathiness and dryness while decreasing risk for nodules/polyps forming due to irritation/overworking of vocal cords.
SLPs use various approaches to teach individuals how to produce resonant voices. One such technique uses a straw as backpressure during phonation to regulate airflow and promote balanced vibrations of vocal folds. Other techniques may include using humming as well as voiced and voiceless sounds shaped into phrases or sentences with positive practice, negative practice in which patients attempt to retreat into their throats.
SLPs may also teach patients articulation and fluency techniques to increase voice clarity. This may involve teaching them how to produce consonant clusters with stronger, more consistent vowel sounds; deviate at rounded and onset-timed sounds; elongate consonants; as well as how to deviate at rounded and onset-timed sounds and elongate consonants – techniques which are particularly helpful with patients suffering from articulation disorders.
Cochlear implant users may benefit from using aural (re)habilitation techniques to normalize hypernasal speech, which is common among this population. To accomplish this goal, tactile feedback such as chewing or humming sensations and facial and nasal bone movement during these activities may provide information. For more on aural (re)habilitation please visit ASHA’s Practice Portal page Language and Communication of Deaf and Hard of Hearing Children
Resonance therapy aims to give people a strong, clear, and effortless voice they can use both at work and home. This will enable them to feel more confident during presentations while engaging audiences more fully; connect better with family members; foster harmony within the home environment; or express themselves more freely socially to make a lasting impression with new acquaintances.
3. Vocal Stability
Vocal stability refers to how easily an individual is able to produce and sustain speech sounds for long durations, as well as whether their voice remains consistent from moment to moment regardless of environmental and physical changes. Speech therapy treatment goals for vocal stability typically focus on decreasing breathiness while creating a steady, strong voice.
Strong voices depend on having a healthy larynx, the tissue which holds and protects vocal cords during phonation. Therefore, it is essential that any treatment plan for voice problems include an assessment of your client’s larynx health prior to beginning treatment programs.
The therapist will begin by asking about any history of voice problems, while their client should describe how their current voice feels. This information will allow the therapist to determine whether it’s normal or abnormal; for example, weak or breathy vocal cords may indicate tightening from strain; in this instance, rest and exercise might help loosening them up.
Another method for assessing vocal health is through conducting a nasal obstruction test. To conduct such an exam, a therapist will have their client close their nose and pronounce some consonant sounds; if these appear muffled or suppressed then that could indicate Velopharyngeal Dysfunction in their voicebox (for more information see ASHA Practice Portal page on Velopharyngeal Dysfunction).
If a therapist suspects a resonance disorder, they will examine the anatomy of both mouth and nose to ascertain its source. A repaired cleft palate could result in an abnormal or fixed opening (VPI) of soft palate which can result in hypernasality; on the other hand, large tonsils or evidence of mouth breathing could indicate obstruction leading to hyponasality.
Occasionally, if swelling or inflammation are the source of an abnormal VPI reading, antihistamines or steroids may be prescribed to decrease sinus pressure and increase nasal airflow.
Resonance disorders often affect quality of life. Therapists may suggest behavioral techniques and strategies, such as hypernasality tips from this post’s Hypernasality section, to increase clarity during phone conversations.
4. Vocal Expression
As we speak, our vocal folds vibrate to generate sound that passes through oral cavities, nasal cavities and the pharynx like filters to shape what others hear. Their sizes and shapes as well as where the tongue rests determine quality and pitch of sound that others hear; position of tongue determines quality/pitch of tone produced when speaking; the velopharyngeal valve closing properly is also critical; failure may result in various resonance disorders for speakers.
Structural causes of VPDs include an overt or submucous cleft palate; irregular adenoids/tonils protrusion into the pharynx which preclude proper closure; post-tonsillectomy enlargement of lateral wall interfering with movement (asymptote); narrow Palatine Fenestrae; Pterygopalatine Fistula and Tumors are other possible obstructions; while behavioral therapy cannot correct resonance disorders that are caused by structural factors; however, behavioral therapy can improve speech quality when symptoms stem from nonstructural issues such as poor placement of sounds/inappropriate motor planning/execution for specific sounds.
Behavioral resonance therapy entails teaching patients the most efficient use of their voices for particular sounds, whether initial /r/ or final /s/, through an approach known as ‘sounding out,” where an SLP directs patients to produce it different ways and listens for any variation that achieves desired results. Sounding out is an integral component of treating VPD since it allows clinicians to determine which production methods produce results most efficiently.
Therapists can also help reduce the impact of VPD by suggesting various management options, including changing or avoiding certain foods and drinks that cause irritation to the voice, taking antihistamines and steroids to reduce swelling, and teaching patients how to manipulate their tongue or other areas of their mouth/vocal tract to brighten or darken resonance depending on specific speech sounds.
