Speech-Language Pathology Services

Your voice can be injured from overuse (resulting in small “bumps” on the vocal cords) or from medical problems (asthma, acid reflux) you might be experiencing.  Vocal fold paralysis (damaged nerves in the larynx) can render a person “speechless.”

Vocal rehabilitation or voice therapy is provided by a ceritfied speech-language pathologist. Many insurance plans include speech pathology coverage.

In addition to treating voice disorders, we specialize in problems related to asthma, which can create problems managing an adequate flow of air necessary for the production of a normal voice.  Problems of chronic cough are managed by identifying specific triggers and providing breathing techniques to eliminate the cough. Vocal cord dysfunction, a very frightening problem, affects someone’s ability to breathe.  Appropriate breath management is necessary to retrain paradoxical vocal cord movement.

Voice therapy typically consists of several components.  A vocal hygiene program is designed to eliminate injurious vocal habits.  The training phase consists of exercises for changing the way you use your voice, then strategies are provided so you can effectively use the therapy techniques in daily communication.
In most cases, complete recovery can be achieved from these common voice problems: soreness, fatigue,hoarseness, tightness/strain, weakness, inappropriate pitch or difficulty being understood.

Voice problems can be difficult to understand.  You will be provided with information about the nature of your problem and what is necessary to effectively treat it.

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Patients with Parkinson disease and other neurological voice problems are provided with a specialized treatment approach (Lee Silverman Voice Treatment) which has been proven to be highly effective in restoring the strength of the voice.

Spasmodic dysphonia is a debilitating voice disorder.  Patients diagnosed with this disorder are provided with a specialized program of exercises to help effectively manage this problem.


Asthma is a chronic respiratory disease that affects your airway (the tubes that carry air in and out of your lungs). If you have asthma, the inside walls of your airway become inflamed (swollen). The inflammation causes your airway to become narrower and less air flows.  Wheezing (a whistling sound when you breathe), coughing, chest tightness, and trouble breathing occur.  Asthma is a manageable condition–with proper understanding, good medical care, and monitoring, you can keep asthma under control.

If you have asthma you are not alone. In the United States, asthma affects 14 to 15 million people. Today, 10 million adults have asthma. Asthma, also known as reactive airway disease, is defined as a chronic lung condition with:

  • Inflammation (swelling) of the airways
  • Increased sensitivity of the airways to a variety of things that make asthma worse
  • Obstruction of airflow

People who have asthma and use their voices excessively for their work (teachers, singers, public speakers, salespeople) or life-style (vocally expressive people) may experience hoarseness, soreness or vocal fatigue.  A short course of voice therapy (prescribed by your doctor) may help.

Go to www.njc.org or www.nhlbi.nih.gov for more information.

Vocal Cord Lesions

The term vocal cord lesion (physicians call them vocal “fold” lesions) refers to a group of noncancerous (benign), abnormal growths (lesions) within or along the covering of the vocal cord. Vocal cord lesions are one of the most common causes of voice problems and are generally seen in three forms; nodules, polyps, and cysts.

Vocal Cord Nodules
    Vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped.

Vocal Cord Polyp    A vocal cord polyp typically occurs only on one side of the vocal cord and can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide range of voice disturbances.

Vocal Cord Cyst     A vocal cord cyst is a firm mass of tissue contained within a membrane (sac). The cyst can be located near the surface of the vocal cord or deeper, near the ligament of the vocal cord.  As with vocal cord polyps and nodules, the size and location of vocal cord cysts affect the degree of disruption of vocal cord vibration and subsequently the severity of hoarseness or other voice problem.

Reactive Vocal Cord Lesion     A reactive vocal cord lesion is a “bump” located opposite an existing vocal cord lesion, such as a vocal cord cyst or polyp. This type of lesion is thought to develop from trauma or repeated injury caused by the lesion on the opposite vocal cord. A reactive vocal cord lesion will usually decrease or disappear with voice rest and therapy.

What Are The Causes Of Benign Vocal Cord Lesions?     Lesions are thought to arise following “heavy” or traumatic use of the voice, including voice misuse such as speaking in an improper pitch, speaking excessively, screaming or yelling, or using the voice excessively while sick.

Vocal Cord Dysfunction

Vocal Cord Dysfunction (VCD), also known as Paradoxical Vocal Cord Motion (PVFM) can closely mimic asthma symptoms and complicate making a proper diagnosis.

Symptoms of VCD include:

  • Shortness of breath
  • Intermittent hoarseness and/or wheezing
  • Chronic cough and/or throat clearing
  • Chest and/or throat tightness
  • “Just having trouble getting air in.”

These symptoms are a result of an abnormal closing of the vocal cords (VCD) rather than inflammation of their airways (asthma).

In 1983, doctors at National Jewish described this condition and speech therapy became a major treatment (in addition to other medical treatment).

See www.njc.org

Vocal Fold Paralysis

What is vocal cord paralysis?

We each have two vocal cords (folds). The vocal cords vibrate when we speak which produces our voice.

There are two sets of nerves which innervate the vocal folds.  The “major” nerve is called the recurrent laryngeal nerve (RLN) and is responsible for most of the work or movement of our vocal folds (opening, closing).  When the RLN is injured, the voice is very, very weak and sometimes the person can only speak in a whisper.

The “minor” nerve is called the recurrent laryngeal nerve (SLN) and is the “pitch-increasing” muscle.  When we intend to raise our pitch, this nerve causes only a single muscle in the larynx to contract which stretches or elongates the vocal folds and the pitch of our voices go higher.

One or both or any combination of paresis (weakness) or paralysis (non-working) can occur. Symptoms vary,  but usually include:

  • hoarseness
  • breathy voice
  • inability to speak loudly
  • running out of air when you speak
  • limited pitch and loudness variations
  • voicing that lasts only for a very short time (around 2-3 seconds)
  • choking or coughing while eating
  • possible pneumonia due to food and liquid being aspirated into the lungs (the vocal cords cannot close adequately to protect the airway while swallowing)

These types of injuries to the larynx having a debilitating effect on the person.

The Ariel Project Suddenly Silent  is a wonderful website for patients (and loved ones) who have experienced the devastating communication effects of having a vocal fold paralysis. Please visit their site and post your comments.