OHSU

Voice & Swallowing - Rehabilitation

What will the doctor do after my treatment?

This page gives you information regarding the possible treatments for some of the more common voice and swallowing related disorders. Note: The information contained in these pages is for educational purposes only. It should not be considered to be individualized diagnostic and treatment advice.You should talk with your doctor about the possible treatments for your situation.

The therapists in our clinic are specially trained to provide specialist rehabilitation of voice & swallowing function with the physicians and surgeons in our clinic.
Complete list of our staff.
Below are listed a variety of the treatments and services that we offer.


Select a Treatment Topic
Voice Therapy
Lee Silverman Voice Treatment
Therapy for the Aging Voice
Paradoxical Vocal Cord Dysfunction (VCD) Treatment
Swallowing Treatment
Therapy for the Head & Neck Cancer Patient

 

VOICE THERAPY

Most people will experience hoarseness at some time, usually related to a cold or after a period of a lot of voice use, such as yelling at a football game.  This rough, scratchy voice will usually last for a few days and then the voice quickly returns to normal.  Any change in voice that lasts for more than two weeks may indicate a more serious problem and should be checked by a doctor. Ongoing (chronic) hoarseness can be caused by many different voice reasons. Common voice complaints include, but are not limited to: hoarseness, poor vocal quality, fluctuating voice, vocal tiredness, effortful voicing, pitch changes, poor vocal control, weak voice, and pain or discomfort with voicing.

The evaluation of a voice problem can be complex, so at our clinic the Laryngologist and Speech-Language Pathologist work closely with each patient to fully understand the problems you are having with your voice, the physical and emotional impacts of the voice problem, and the impact of the voice problem on the patient’s daily life.  Evaluation is completed by both the Laryngologist (doctor), who will provide a medical diagnosis and the appropriate medical or surgical treatment plan, as well as the Speech-Language Pathologist, who evaluates both the vocal function and the patient’s vocal use.   Comprehensive treatment of a voice disorder may involve medical treatment, surgical treatment, voice therapy, or a combination of these methods.  Voice therapy is frequently recommended to do along with medical or surgical treatment to promote healing and prevent further vocal injury by training the patient to use the best possible vocal technique.

The primary goal of voice therapy is to achieve the best possible voice with the least amount of voicing effort.  This will hopefully reduce or eliminate the voicing difficulties.  The structure of voice therapy sessions is tailored to each patient’s specific vocal complaints, diagnosis, and needs.  Voice therapy sessions include: education about how the voice works, exercises to strengthen and make the most of the voice, training and practice of the best possible vocal technique, and learning how to best manage and care for the voice.  The best vocal quality is achieved through a balance of good breath support, phonation (sound created by the vocal folds), and resonance (how the sound travels through the mouth and nose cavities).  Exercises and treatment tasks will cover each of these areas.   

The Speech-Language Pathologists and Physicians in our clinic are also specially trained to evaluate and manage the unique vocal demands of professional voice users and singers.  Professional voice users include any patient who relies on their voice to work in their profession, such as teachers, sales personnel, ministers, actors, etc.  We consider every component of each patient’s daily voice use when setting up the treatment plan and encourage patient participation in that process.  For singers, the evaluation will include a comprehensive assessment of both the speaking and singing voice and voice therapy will include training, as needed, in both areas.  This allows us to consider how the speaking vocal technique may affect the singing voice, and vice versa.  We can also work closely with our patient’s singing teacher or voice coach for the best performance outcomes.


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LEE SILVERMAN VOICE TREATMENT

Lee Silverman Voice Treatment or “LSVT” is a voice treatment program that has been designed specifically to treat the communication problems associated with Parkinson disease.

For more than 15 years, National Institute for Deafness and other Communication Disorders (NIDCD) of the National Institutes of Health (NIH) have supported studies that have demonstrated that LSVT is an effective treatment for speech and voice disorders related to Parkinson disease.  These studies have demonstrated that LSVT can result in improved loudness, intonation, vocal quality, articulation and facial expression.  

LSVT is an intensive voice treatment program that involves 4 treatment sessions per week over the course of 4 consecutive weeks.  The focus of LSVT is on loud voicing across a variety of tasks. Each week the tasks increase in difficulty so that by the end of treatment, the focus is on using the new loud voice in conversation in all areas of the patient’s life.   People with Parkinson disease often speak softly but are capable of speaking loudly.  An individual may feel that he or she is speaking at a normal loudness level when they are actually speaking softly.  This is due to changes in the brain rather than a change in hearing. In therapy, we work on habituating normal loudness by focusing on “thinking loud”.

In addition to the therapy sessions, the participant will be given exercises to complete at home. The intensity of the program is necessary to change the pattern of speaking and improve communication. This technique has helped many individuals with Parkinson disease and other speech problems find new hope for improved communication in work, family and social activities.

Many individuals who participate in LSVT experience a new-found confidence in their ability to communicate. Patients report that they are able to participate in conversation, they are resuming activities that they had discontinued due to their communication problems and they can communicate in groups much more effectively.  LSVT is a therapeutic method that helps people with Parkinson disease have some control over at least one aspect of this disease.  The earlier the communication problems associated with Parkinson disease are addressed, the more likely the person with Parkinson disease will be able to maintain communication skills over time and preserve this key element in quality of life.

At OHSU, we have several LSVT-certified clinicians who routinely provide this treatment in our clinic.


THERAPY FOR THE AGING VOICE

Voice therapy can often be very beneficial to the person experiencing age-related changes in the voice. Exercises taught in voice therapy often can improve strength and vibration of the vocal folds. This is done by working on very specific exercises as well as teaching the patient to use the voice efficiently in conversation. These exercises and techniques often improve vocal quality and voice projection and reduce vocal fatigue and effort.  If the gap between the vocal folds is large and the patient does not respond to voice therapy, there are surgical procedures available to improve vocal fold closure.

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TREATMENT OF PARADOXICAL VOCAL CORD DYSFUNCTION

Paradoxical vocal cord dysfunction (VCD) is a condition in which the vocal cords move paradoxically during breathing, which means that the vocal cords tend to close when it should open causing noisy breathing and shortness of breath. During a first VCD attack, symptoms can feel so severe and frightening that many individuals go to an emergency room to seek treatment.  Often the symptoms will resolve quite quickly and the breathing will return to a more normal pattern as soon as the individual is sitting and relaxing. 

In order to control and hopefully prevent further VCD attacks from happening, speech therapy from a speech pathologist with a specialization in this area is recommended.  Treatment consists of teaching strategies to help maintain open and relaxed breathing throughout the day, to prevent  problems, and rescue strategies to help get out of an attack.  These breathing strategies often help to lessen the panic that usually happens with the shortness of breath of VCD.  The speech therapist can also help the individual to recognize the causes for the attacks and to use breathing strategies around those causes, so attacks don't happen.  Relaxation techniques may also be used.  Laryngoscopy  (looking at the throat and vocal cords with a camera) can be used  to allow an individual to see the vocal cords while trying various strategies to try to keep them open and relaxed.  Treatment is typically quite successful and the problem either goes away completely or is very controllable.  Therapy typically takes 3 to 5 sessions to get the symptoms completely under control.  For treatment to be successful, however, the individual with VCD must be motivated to use and practice the strategies they have learned outside the therapy session.

Many of these treatment strategies can also benefit individuals with chronic cough.

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MANAGEMENT & TREATMENT OF SWALLOWING DISORDERS (DYSPHAGIA)

Diagnosis of swallowing disorders may be accomplished in a number of ways:

  • An interview, examination of the structures of the mouth and throat and observation of normal eating and drinking behavior together with information about an individual’s medical history is often the first step in the diagnostic process and is known as a clinical evaluation of swallowing.
  •  Another exam may be conducted in which an individual eats food and liquid mixed with barium and is observed with X-ray known as a videofluoroscopic swallowing study or a modified barium swallow.
  • Another exam is conducted with a small, flexible scope which is passed along the nostril and allows visualization of the throat and voice box during breathing, voicing and swallowing. This is known as a fiberoptic endoscopic evaluation of swallowing or FEES study.

Treatment of swallowing disorders usually involves a number of elements including:

  • Strategies for the individual and/or caregivers regarding the best position, speed and method for eating/drinking
  • The best diet and textures/consistencies to avoid choking or aspiration
  • Exercises designed to increase the range of motion, speed and strength of the muscles involved in swallowing
  • Electrical stimulation of weakened muscles may be used to enhance the effects of a home exercise program, in some cases
  • Biofeedback, a technique in which an individual can monitor their swallowing behavior on a screen or on handheld device in order to better reach treatment targets.

Surgical options for swallowing problems depend on the severity of an individual’s difficulties but can include:

  • A tracheostomy tube due to chronic difficulties with breathing or aspiration
  • A feeding tube which may be used for adding nutrition or as the primary method for obtaining nutrition and hydration due to severe swallowing difficulties
  • When an individual has a stricture of the esophagus (an area of scar tissue forming an obstruction to the passage of food/liquid) an esophageal dilation can be performed. The procedure occurs while the individual is anaesthetized and involves passing a tube through the narrowed area in order to stretch it. This may be repeated periodically, as needed.
  • When there is a muscle spasm or Zenker’s diverticulum (a small pouch) at the border of the throat and the esophagus, a Botox injection may cause the spasm to relax or the muscle may be cut (a myotomy) to prevent it obstructing the passage of food & liquid. 


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TREATMENT AFTER HEAD & NECK CANCER

Cancer is the second leading cause of death in the United States, and is responsible for 1 in 4 deaths. For cancers of the head and neck, the decision to use surgical resection, radiation therapy, and/or chemotherapy is typically based upon the size and location of the tumor, and the presence or absence of metastasis (spreading of the cancer to other areas). All three treatments, in isolation or in combination, have a negative impact on speech and swallowing function. Some individuals require extensive rehabilitation after successful completion of head-and-neck cancer treatment. This is usually multidisciplinary (several doctors or specialists from several medical fields). In order to resume an oral (through the mouth) diet many individuals require speech and swallowing therapy for the structures of the mouth and throat, which involves exercises for the muscles of the mouth and throat which have been affected by cancer treatment. Some individuals with laryngeal cancer may require rehabilitation of the voice or, when the laryngeal cancer has been extensive, assistance in developing a different method of communication such as after laryngectomy (removal of the larynx). We aim to provide a full range of  speech, voice, swallowing and communication rehabilitation after head-and-neck cancer treatment either with the physicians in the Department of Otolaryngology-Head & Neck Surgery and Oncology at OHSU or with an individual’s referring physician outside OHSU. Usually, treatment involves periodic visits with a home treatment program of exercises or strategies to be performed on your own. We often coordinate with other professionals such as physical and occupational therapists, dieticians, and other physicians to provide the total care needed by the patient. When an individual does not live within the Portland Metro area, we are happy to coordinate services with a Speech Pathologist who works at a location closer to that individual’s home, wherever possible.

 

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How to Make an Appointment

Please contact our office regarding scheduling appointments. Prior to scheduling an appointment, our providers often need to review chart notes related to the reason you want to be seen in order to coordinate any additional tests they may need in order to make the most of your visit.  In some cases, we will require a referral from your primary care physician.  We would be happy to discuss this with you to ensure we have all we need to expedite the scheduling process.  Please contact us by phone or email to begin the process. 

Phone: NW Clinic for Voice & Swallowing  503 494-5947
Email:

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appointments

For information about appointments in the NW Clinic for Voice and Swallowing, please call 503 494-5947.