What is voice therapy?
The aim of voice therapy is to eliminate or improve problems with the creation of vocal sounds (phonation) in the larynx (voice box). After completing therapy, your voice should be stronger and sound like it did before. Voice therapy can also be used for prevention, to train your voice in order to avoid such problems altogether.
Voice therapy includes various individually tailored exercises that can be learned from a speech therapist, voice coach or respiratory therapist. In Germany, statutory health insurers typically cover the costs of voice therapy if it is necessary and has been prescribed by a family doctor or an ENT specialist.
When is voice therapy a good idea?
Voice therapy is suitable for most types of voice disorders (dysphonia). A voice disorder is a persistent change in someone’s voice. The voice is then often hoarse, but it might also be strained, husky or soundless. It is then weaker and less powerful too: For instance, someone with a voice disorder may not be able to hold a key for as long as they could before. Or they may no longer be able to sing very high or low notes, or speak in a very high or deep voice. Sometimes, a person’s voice may disappear altogether (aphonia).
What kind of voice disorders are there?
Voice disorders can be caused by a wide variety of things. They can be grouped into:
- Functional voice disorders: These can arise from speaking frequently and loudly. Some people use too much force or tension when speaking, without being aware of it. This might be because they are very stressed or have got into the habit of using an unfavorable breathing technique. Others may speak in a register that isn’t right for them.
- Organic voice disorders: These are caused by changes affecting the larynx. But physical changes such as vocal nodules may result from a functional voice disorder too. Paralysis of the vocal cords – which can occur after thyroid surgery, for instance – is another common organic voice disorder. Other causes include smoking, inflammations, stroke or laryngeal (larynx) cancer.
- Psychogenic voice disorders: Here the voice becomes hoarse, cracked, or completely silent after a distressing event, persistent stress, or as a result of a mental illness such as depression.
What does voice therapy involve?
You typically see a therapist once or several times a week for a few months. Each session of therapy usually lasts 45 minutes. It is also sometimes possible to do online sessions at home on the computer.
Voice therapy may include the following exercises:
- Breathing exercises – for example, practicing using your diaphragm more when breathing, or learning to better coordinate your speech and breathing.
- Relaxation exercises to reduce tension.
- Movement or posture exercises to improve your posture.
- Exercises for the mouth and jaw muscles – for instance, using chewing movements or intentional yawning and sighing.
People who don’t speak in the right register can practice speaking in a better register.
There are different kinds of approaches to the therapy and the exercises. Different exercises will be suitable for different people, depending on individual factors and the cause of the voice disorder: If fears and anxiety play a big role, that will be taken into consideration in the therapy. Then it may be a good idea to consider having psychological treatment too.
It’s also difficult to speak if you can’t move your tongue, mouth or jaw properly. Then the problem is not the voice, but the fact that it’s hardly possible to produce understandable speech with vocal sounds. Doctors call that a speech disorder or speech impediment (dysarthria).
Voice disorders and speech disorders can occur together – for instance, after a stroke or in other neurological conditions like Parkinson's disease. It may be hard to swallow, too. Then speech therapy and swallowing therapy are also needed in addition to voice therapy. That involves doing suitable exercises to improve the formation of vocal sounds in your mouth and throat (articulation) and training the muscles you use to swallow in order to make it easier to eat and drink.
What can you do on your own?
If you have voice therapy, it’s important to also practice at home and not just during the sessions with the therapist. Even once you’ve completed the therapy, it's worth making regular exercises a part of your daily routine.
It’s also important to not overuse your voice in everyday life. Instead of raising your voice to compete with loud background noise, you could try to find a quieter place to have longer conversations or – if that’s not possible – find a way to rest your voice enough. It isn’t a good idea to whisper because that puts a lot of strain on your vocal cords. If you want to go easy on your voice, it's better to try to speak less.
All of the things that you can do to keep your voice healthy are often summed up as “vocal hygiene.”
Deutsche Gesellschaft für Phoniatrie und Pädaudiologie (DGPP). S1-Leitlinie Funktionsdiagnostik und Therapie von Kommunikationsstörungen bei neurogenen Sprech- und Stimmstörungen im Erwachsenenalter, Funktionsdiagnostik und Therapie. AWMF-Registernr.: 049-014. September 18, 2014.
Lenarz T, Boenninghaus HG. Hals-Nasen-Ohren-Heilkunde. Berlin: Springer; 2012.
Mansuri B, Tohidast SA, Soltaninejad N, Kamali M, Ghelichi L, Azimi H. Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review. J Voice 2018; 32(5): 609-620.
Pschyrembel. Klinisches Wörterbuch. Berlin: De Gruyter; 2017.
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