Tor Spence – speech and language therapist

I’m a speech and language therapist (SLT) specialising in working with the larynx (voice box) and the upper part of the respiratory system — including the throat, mouth and nose. My patients are adults and children who may have a hoarse voice, a feeling of a lump in the throat, persistent dry cough, swallowing problems, or breathlessness associated with voice box dysfunction.

The classification of voice disorders is quite complex; it continues to be studied and evolve. A voice disorder can be classified into one of four categories: structural, neuromuscular, inflammatory, or muscle tension imbalance. An example of a structural lesion is a cyst, which can form within the vocal cord. An example of a neuromuscular disorder would be vocal cord paralysis (when one or both vocal cords stop working because of damage to the nerve that carries messages from the brain to the voice box muscles). An example of an inflammatory voice disorder is swelling or inflammation caused by the reflux of gastric contents up from the stomach as high as the throat. If someone’s voice has changed and the voice box looks healthy, the most likely cause of a voice disorder is muscle tension or strain. In a clinical setting, I see patients with a huge range of voice disorders – sometimes more than one disorder at a time.

A voice disorder is diagnosed by examining the voice box, listening and rating the voice quality and asking the patient to self-rate the severity and frequency of their symptoms and the impact they’re having on quality of life. Visual examination of the throat and voice box is performed, with a long flexible camera inserted through the nose (to view the vocal cords from above) or via the mouth, using a rigid camera or scope.

Research shows that combining education and support for patients alongside direct therapy exercises results in good voice outcomes. Therapy techniques vary depending on diagnosis and other factors. When working with voice patients, key parts of my therapy plan include education and awareness-building (explaining how the voice works and the diagnosis’ impact), vocal hygiene or voice care guidance, which might include support with medications and hydration advice, support for reducing vocal demands, acid reflux management or general health advice, and counselling techniques, for example, support with acceptance, and motivational interviewing to help patients cope with the psychological and social aspects of living with hoarse voice, as well as any stress that might be contributing to it.

Additionally, there are direct therapy techniques, including breathing exercises, muscle relaxation work and voice exercises designed to promote good vocal cord vibrations and rehabilitate the voice: some familiar voice exercises include humming, lip trills, blowing through straws and pitch glides.

COVID-19 has caused a range of persistent voice and throat symptoms in many patients, which led to an increase in referrals. Long COVID teams are referring patients to speech therapy with voice change, swallowing problems and throat symptoms: soreness, persistent cough and hypersensitivity. I work with a respiratory physiotherapy service; we often team up to work with patients with breathlessness and laryngeal symptoms. I saw someone just today with a persistent dry cough and a feeling of difficulty swallowing post-COVID. The pandemic quickly led to the development of online therapy services and this has changed the nature of my role – it’s meant that I can make therapy more convenient and reach a greater range and number of patients.