Adult Voice Services
Muscle Tension Dysphonia
When a person exerts or carries excessive muscle tension in their vocal, throat, abdomen, and/or neck muscles, they may develop muscle tension dysphonia (MTD). This dysphonia can be characterized by hoarseness, breathiness, vocal fatigue, vocal strain, pain when speaking, loss of voice, a sensation that something is in the voice box or throat ('globus sensation'), pitch breaks, voice breaks, shortness of breath, reduced pitch range, and reduced vocal intensity. MTD can be associated with a medical condition that causes excessive muscle tension, by psychological stress (e.g., an anxiety disorder), exposure to an irritant, or maladaptive speaking behaviours (e.g., teachers who use their voices for prolonged periods of time each day). It may also develop after a respiratory illness (e.g., a cold or pneumonia) or reflux when an individual enters a cycle of frequent coughing, increased muscle tension, and over sensitivity in the larynx.
MTD can be classified as 'primary MTD' when there is no structural or neurologic abnormality causing the muscle tension. It is classified as 'secondary MTD' when the tension results from other conditions affecting the vocal mechanism (e.g., nodules).
MTD may also be known as hyperfunctional voice disorder, spastic dysphonia, functional dysphonia.
Treatment for MTD may include a combination of laryngeal massage, modifying maladaptive speaking behaviours, improving vocal hygiene, and vocal exercises.
People with MTD often also benefit from working with other professionals in conjunction with speech therapy. Physiotherapists with expertise in vocal physiotherapy can offer treatment to help decrease muscle tension and build strength in the extrinsic laryngeal muscles, and the muscles of the jaw, tongue, neck, shoulders, torso, and respiration that contribute to voice production. Cynthia Murphy, PT, of Scotia Physiotherapy in Halifax offers such treatment for persons with MTD. Learn more here: https://scotiaphysiotherapy.ca/service/vocal-physiotherapy/.
Johns Hopkins Voice Center
University of Pittsburgh
Transgender Voice Modification
Achieving a feminine, masculine, or neutral voice involves consideration of pitch, resonance, vocal quality, prosodic patterns (e.g., intonation and rate), and nonverbal communication (e.g., gesture, posture, body position relative to others). While hormones frequently lower the pitch of trans men's voices over time, hormones for trans women do not have an effect on pitch. Each of these characteristics, however, can be modified through voice training.
Speech-language pathologists are among the voice professionals who work with trans men and women to help them achieve their goals for a gender congruent voice while preserving the health of their voice mechanism. It is recommended that trans men and women who are working toward achieving their ideal voice do so with the support of a psychologist or clinical therapist while working with an appropriate voice professional.
This process of voice modification requires time and practice, but is achievable. You can expect to visit with a speech-language pathologist weekly over a number of months. The process will also involve daily home practice.
"Voice and Communication Change for Transgender People", American Speech-Language-Hearing Association
by Matthew Mills & Gillie Stoneham
(This book is part of Shoreline's collection and can be borrowed by clients of any of the health professionals at Paddlers Cove Professional Centre.)
Neurogenic Voice Disorders
Performers and Singers
Performers and singers who require voice rehabilitation are best served by SLPs with vocal performance experience and knowledge. Unfortunately, that is not within our area of experience at Shoreline at this time.
Public Service Options
Residents of Nova Scotia have access to voice therapy services appropriate for vocal performers through the MSI program with Nova Scotia Hearing and Speech (NSHS). NSHS has locations throughout Nova Scotia. Please contact them directly to ask about service in your area.
Private Service Options
To search the registry of the Nova Scotia College of Audiologists and Speech-Language Pathologists, click here. Some options for local private practice services are provided below. This list is not inclusive and does not imply endorsement by Shoreline Speech Therapy.
Based in Fall River, Heather MacLean offers mobile services (during the COVID-19 pandemic she is providing services through telepractice).
There are a number of SLPs with such backgrounds who practice in Ontario and provide virtual care. Based on the Audiologists and Speech-Language Pathologists Act in Nova Scotia, residents of Nova Scotia may receive services virtually from SLPs licensed in other Canadian jurisdictions. Below is a list of some of these practitioners. This list is not inclusive and does not imply endorsement by Shoreline Speech Therapy.
Talk Inc. Speech, Language, & Voice Therapy
Speech Appeal Toronto Adult Voice & Speech Therapy
Melanie Tapson Voice Care
Toronto Adult Speech Clinic
A clinical voice evaluation typically includes the following:
analysis of your voice (e.g., loudness, quality, and pitch range)
evaluation of the impact of voice changes on your daily life and your family
discussion of your goals for intervention
identification lifestyle factors contributing to voice issues
oral mechanism exam (examination of oral structures required for speech)
evaluation of candidacy for treatment
prognosis for improvement with treatment
review of reports from other professionals (ENT, audiologist, family doctor, neurologist)
Please bring the following to your appointment or send them ahead of time. If you do not have access to these reports, please just bring the name/contact information of the health professional who provided the service. With your consent I will be able to request these reports on your behalf.
results of any recent hearing test
copy of relevant reports (e.g., ENT)
list of medications
medical history (if you have a history of cardiac disease or surgery, medical clearance may be required before starting voice treatment)
Part of a voice evaluation includes completion of a laryngeal exam by an Ear Nose and Throat (ENT) doctor ('otolaryngologist'). Your doctor can make this referral. For a laryngeal exam, the ENT (or specially trained S-LP) will place a scope in your mouth so that they can look down your throat to your vocal folds. This scope only goes to the back of your mouth. In some cases, a flexible scope may need to be passed through your nose to your throat. Topical anesthetic will be used to make this more comfortable. From this position, your vocal folds can also be viewed. The ENT/S-LP will discuss this with your before starting the procedure. The laryngeal exam is important in order to identify or rule out any structural reason for the voice changes you are experiencing (e.g., nodules).
University of California, Irvine
Department of Otolaryngology
Yavapai Regional Medical Center
Rigid Videostroboscopy Procedure (video)
Swallowing and Neurological Rehabilitation, LLC