Many individuals are at risk for developing a voice disorder from phonotrauma. Phonotrauma is damage to the vocal folds caused by the physical stresses of voice use. It is the result of factors such as excessively loud talking, talking frequently in noisy environments - or simply sustained heavy voice use, as is necessary in a number of occupations. Often, more than one factor is involved.
Because phonotrauma is the result of behavior, modifying voice use is a fundamental means of treating phonotraumatic injury. The two principal means of behavioral treatment are voice rest and voice therapy.
Voice rest (complete silence) or relative voice rest (limited voice use) can be beneficial for treatment of some conditions, such as: vocal fold hemorrhage, laryngitis, swelling from overuse, and post-operative surgical healing. Voice rest is useful principally to reduce swelling. It is important that the terms of voice rest be clearly explained, as some behaviors that may instinctively be seen as helpful, such as whispering, are in fact counterproductive.
Prolonged voice rest (more than a week) is almost never recommended, as it usually only serves to mask the problem and delay effective treatment. Unless the behaviors and conditions that first caused the problem are addressed, symptoms are likely to resume with normal use of the voice.
Voice therapy aims to change harmful vocal behaviors. It consists of education, exercises, and the correction of behaviors that may have created the voice problem (or may have developed to compensate for the problem). Voice therapy is administered by a speech-language pathologist with specific training and competence in voice disorders. The goal of voice therapy is to help the patient find relief from vocal symptoms, and achieve the best voice possible.
Voice therapy should be tailored to suit each individual. The therapy plan should be specific to one’s vocal needs - be they personal, social or professional. Engagement in occupational voice use is usually the single most important risk factor surrounding a voice disorder. A well-constructed voice therapy plan accounts for this in order to optimize voice use and minimize risk of injury.
A typical course of voice therapy involves six to eight, weekly, 45-minute therapy sessions. However, this varies depending upon the diagnosis, response to treatment, and patient adherence to recommendations. The initial session involves determining a detailed case history, obtaining objective and audio-perceptual voice analysis, and undergoing exercises to test patient stimulability. Some voice disorders are completely treatable by voice therapy. Other voice disorders cannot be completely, but therapy can help compensate in the healthiest way possible.
Voice therapists may also treat symptoms that are related to the larynx, but not necessarily to voice production - such as airway and breathing conditions, chronic cough and throat clearing, and swallowing difficulty (dysphagia). Some of these conditions may exist concurrently with a voice problem, especially in the case of complex neurological diseases. In these cases, the voice therapist serves as a member of the treatment team, which may include several other specialists.