Treatments: Voice

This page elaborates on treatments for the voice and the larynx.

Diagnosis

Treatment of a voice problem begins with an evaluation of the problem, including history and physical exam by an otolaryngologist and determination of the cause(s) of the voice problem. Depending on the cause identified, an individualized treatment plan is recommended.

Adopting healthy and efficient speech use patterns, called vocal hygiene, is fundamental to improving a voice problem. Speech therapy can help immensely to identify deficits or patterns of traumatic voice use and provide specific exercises to help regain healthy habits, including strengthening of the vocal cord muscles and improving breathing technique. Vocal rest and hydration are often recommended to soothe irritation. In some cases, medication or surgical procedures may be necessary to treat underlying conditions affecting the voice. Ultimately, a personalized approach guided by an otolaryngologist and/or speech-language pathologist is key to restoring and preserving optimal vocal function.

Treatment depends on the cause. Options include:

• Watchful waiting for hoarseness likely caused by a cold, since most cases resolve on their own.

• Voice rest and vocal hygiene (see tips below). Whispering should be avoided, as it can strain the voice as much as loud talking.

• Treating the underlying cause, such as reflux management, allergy treatment, or adjusting a medication—guided by what the exam shows.

• Voice therapy with a speech-language pathologist. This is a highly effective, first-line treatment for many voice problems, including vocal fold nodules, muscle tension, and voice overuse, and it helps across all ages. For people with Parkinson disease, a specialized program (Lee Silverman Voice Treatment) is particularly effective.

• Surgery, reserved for certain growths, some cases of vocal fold dysplasia or cancer, airway problems, or benign lesions that do not improve with conservative care.

• Team care for performers. Singers and actors often benefit from working with a singing coach or voice coach alongside medical and voice therapy care.

Vocal Hygiene: Protecting the Voice

These habits help prevent and improve many voice problems, and are especially important for teachers, singers, and other heavy voice users:

• Stay well hydrated. Drinking water regularly matters; dehydration increases the risk of voice trouble.

• Avoid yelling, shouting, and prolonged loud talking. A microphone or amplifier helps when speaking to large groups.

• Rest the voice, especially during and after heavy use or a respiratory infection.

• Avoid smoking, and avoid secondhand smoke.

• Limit alcohol and caffeine, which can dry the voice, and limit drying medications when possible.

• Manage reflux and allergies when present.

• Warm up and cool down the voice before and after heavy singing or speaking.

• Manage stress, which can worsen vocal fatigue.

• Avoid throat clearing and whispering, which strain the vocal folds.