The otolaryngologist and speech-language pathologist are critical members of the voice care team (1). The role of each, however, is different. Patients enter the medical setting with the medical intervention model in mind; namely, is there a medicine or surgery that will fix their voice problem? Whereas otolaryngologists take responsibility for effecting change either medically or surgically, a speech-language pathologist teaches patients to adopt responsibility for behavioral change because, in its most basic sense, voice therapy teaches patients to modify faulty or compensatory vocal behavior. Persuading patients to become responsible for their vocal behaviors may be difficult, but it is paramount to successful voice therapy (2,3,4). Otolaryngologists are the first people to impress this message to their patients: voice therapy is often successful but requires active participation from the patient. Unfortunately, there are high rates of attrition in voice therapy (5,6,7). It is important for otolaryngologists to refrain from saying “I want you to try voice therapy” as often this verbiage can plant the seeds of noncompliance and attrition. In addition, because most patients assume the medical model of rehabilitation, a rapid restoration (i.e., “quick fix”) of voice is expected. Behavioral modification is not a “quick fix” and patients need to understand this basic premise.

A common question posed by otolaryngologists to speech-language pathologists is, “What do you do in voice therapy?” In this chapter, a model of the component parts of voice therapy will first be illustrated followed by a condensed description of some of the most commonly used voice therapies and their applications to specific voice disorders. In addition, approximate treatment durations, reference to appropriate referrals, and limitations to therapeutic success will be discussed.

The Venn diagram in Figure 71.1 illustrates the key categories of any voice therapy program: increase vocal hygiene, decrease phonotrauma, and increase coordinated voice production. Although the circles delineate separate entities, they are not mutually exclusive. This model is very similar to the component parts (i.e., categories) of voice therapy. The speech-language pathologist determines which category (i.e., circle) to work with the patient, so modification of the appropriate maladaptive behaviors can be emphasized. The speech-language pathologist must also realize that patients may be in more than one circle. The first two circles, increase vocal hygiene and decrease phonotrauma, represent indirect approaches to voice therapy, whereby the speech-language pathologist essentially educates the patient concerning how his or her laryngeal mechanism works and what may cause harm. The third circle, increase coordinated vocal production, represents a direct approach to voice therapy; here, the speech-language pathologist directly alters the patient’s speaking technique in an attempt to increase vocal quality and efficiency. Indirect voice therapy usually requires 1 to 2 weekly sessions, whereas direct voice therapy usually requires 4 to 6 sessions (e.g., weekly sessions are ideal but not mandatory). This therapy schedule mirrors preoperative and postoperative therapy, in that patients generally receive 1 to 2 sessions of preoperative voice therapy and 4 to 6 sessions of postoperative therapy. Patients may also benefit from a subsequent series of voice therapy (1 to 3 sessions) months after the initial voice therapy to evaluate transfer and retention of the new vocal behaviors.