Voice & Swallowing Overview

The larynx, or voice box, plays an integral role in assessing changes with voice production, breathing and swallowing. Symptoms related to changes involving this structure, include hoarseness, weak voice, decreased vocal range in singers, throat tightness, sensation of something stuck in the throat, frequent throat clearing, cough, shortness of breath, need for forceful swallowing, pills getting stuck when swallowing, and liquids “going down the wrong tube” when swallowing.

We offer diagnostic tests to help to identify causes of these symptoms, such as fiber-optic laryngoscopy, which is performed by a medical provider. This is a quick, safe, and typically well-tolerated procedure that helps to identify changes to the voice box area such as inflammation, dysfunction of the vocal cords, or even masses in the throat or voice box area that are unable to be seen upon routine physical examinations.

If needed, a medical provider may refer you to one of our speech-language pathologists for a videostroboscopy or fiber-optic endoscopic evaluation of swallowing (FEES), which are more detailed examinations of the throat and voice box area that help to identify both physical and functional changes.

Based on the results of these tests, you may be recommended to follow up with our speech-language pathologists for customized speech or swallow therapy.

Our speech-language pathologists also offer SPEAK OUT!® voice and swallow therapy and The LOUD Crowd® exercise group, which is a two-part program developed for patients with Parkinson’s disease.


Hoarseness & Voice Concerns

The larynx (or voice box) is where we produce our voice. Common symptoms of problems with the voice box include hoarseness, vocal weakness, sore throat, and coughing. We offer several diagnostic tests, performed either by our medical providers or our speech language pathologists, that help to identify the cause of these symptoms.



In office Videostroboscopy

This procedure is recommended by our providers to obtain a more detailed view of your larynx (voice box). This state-of-the-art technology provides a detailed magnified view of the structures of your voice box and uses a strobe light to simulate slow-motion vibration of the vocal folds. This helps assess the way the muscles of speaking are working. One of our licensed, specially trained speech-language pathologists will conduct this study. Typically the results are reviewed the same day with the doctors to determine a treatment plan as appropriate. 


Voice Therapy

Voice TherapyVoice (or speech) therapy is a customized physical rehabilitation program based on the findings of a videostroboscopy. During a session, you work individually with a speech language pathologist, who helps you to achieve improved voice quality and a reduction in associated symptoms, such as sore throat or the sensation of something stuck in the throat. Each patient’s therapy is based on an individualized treatment plan with objectives and goals specific for each patient. Therapy is typically one session per week for 6-8 weeks one-on-one with our speech-language pathologist who has extensive training in voice disorders. A repeat videostroboscopy is performed 4 weeks after completion of speech therapy for your doctor to monitor your progress and the resolution of your symptoms.


Swallowing Difficulties

Swallowing DifficultiesEvery structure, from the mouth to the voice box, has a role in the eating and swallowing process. It is important to identify any problems with these structures that may be affecting your ability to eat and drink. Our providers work closely with our speech language pathologists to fully assess and manage swallowing issues.



Swallowing Evaluation (FEES)

FEESIf you are having difficulty swallowing (or dysphagia), a sense of food sticking, pain associated with swallowing, cough, or a medical condition that puts you are risk for dysphagia, this evaluation, called Fiberoptic Endoscopic Evaluation of Swallowing (FEES), evaluates the upper portion of the swallow, from the mouth to the opening of the esophagus while eating and drinking. This detailed examination will show what is happening in your throat when you eat, drink and swallow your pills and will identify if the muscles involved in swallowing are weak. Based on the results of these tests, you may be recommended by your provider to follow up with our speech language pathologists for swallow therapy.


Swallowing Therapy using IOPI & NMES

Our speech language pathologists formulate a customized treatment plan for those suffering from difficulty swallowing. Therapy involves one-on-one sessions with one of our speech language pathologists involving exercises to improve the strength, tone, mobility and coordination of the muscles involved in swallowing as well as positions and/or strategies to help you swallow more safely and effectively. Exercises, equipment and the amount of therapy sessions recommended will be discussed during your evaluation with our speech-language pathologist.  After completion of therapy, a repeat swallowing test will be performed to monitor your progress and the resolution of your symptoms.

Iowa Oral Performance Instrument (IOPI) uses an air-filled bulb the lips or tongue press against to measure muscle strength and to provide resistance during exercise. Recordings of strength are digitally shown to provide feedback and the ability to increase intensity to maintain muscle overload.

Neuromuscular Electrical Stimulation (NMES) is a non-invasive, painless treatment that uses a small portable stimulator which generates customizable electrical pulses. These pulses flow through a lead wire to a pair of small electrodes placed on the facial muscles or under the chin to stimulate the motor nerves that result in muscle contraction. Therapy involves resistance exercise paired with NMES to improve strength, timing and reeducation of the swallowing muscles.



SPEAK OUT!SPEAK OUT!® voice and swallow therapy and The LOUD Crowd® exercise group, are a two-part programs developed for patients with Parkinson’s disease and related neurological disorders such as Essential Tremor, Lewy Body Dementia, Progressive Supranuclear Palsy and Multiple System Atrophy.

SPEAK OUT!® speech therapy strengthens the muscles used for speaking and swallowing and teaches how to speak with intent and deliberation, using a system in the brain that is less dependent on dopamine. Therapy consists of 12 sessions, 3 sessions per week for 4 weeks, with our speech-language pathologist trained by the Parkinson Voice Project. Together, you and the speech pathologist work through a series of speech, voice, and cognitive exercises. The goal of therapy is to strengthen the muscles used for speaking and swallowing and to teach patients how to speak with intent and deliberation. After completion, a 6-week follow-up appointment will be scheduled with the speech pathologist and a refresher session will be scheduled every 3-6 months for maintenance.

Upon completion of SPEAK OUT!®, you will transition to The LOUD Crowd® exercise class. This maintenance program consists of weekly group sessions where SPEAK OUT!® exercises are performed and participants practice speaking with intent, which converts speech from an automatic function to an intentional act. Since Parkinson’s is a progressive, degenerative condition, maintaining the strength of one’s voice can be a challenge. People with Parkinson’s often struggle with motivation as a result of the lack of dopamine in the brain. The LOUD Crowd® provides ongoing vocal practice, accountability, support, and encouragement. By participating in The LOUD Crowd®, patients have been shown to maintain their SPEAK OUT!® results for more than five years and counting.

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