Appropriate Referrals for Voice Therapy

Jackie Gartner-Schmidt

Voice therapy is highly effective in treating patients with voice disorders. However, the physiological integrity of the laryngeal mechanism dictates ultimate success in voice therapy. Not all patients are appropriate referrals for voice therapy. A proper referral is the key to successful therapy. Although most patients benefit from a brief session (1-4) of voice therapy (education, hygiene, environmental modification and transient behavioral voice modification), multiple voice therapy sessions that directly modify a permanent change in voice are often misguided for certain voice disorders
This presentation will highlight challenging cases of organic voice problems that are less amendable to voice therapy due to physiological limits of the larynx. Four of the most challenging patient populations are those diagnosed with glottal incompetence [atrophy, unilateral vocal fold paralysis, paresis and scar]. A review of the literature regarding the management of these voice disorders reveals a plethora of information related to surgical interventions but little data regarding the efficacy of voice therapy. However, these patients are often on speech-language pathologist’s caseloads for extended periods of time. In addition, tenets of exercise physiology do not fully apply to these patients.
The purpose of this presentation is three-fold: First: to offer guidelines for appropriate referrals for glottal incompetence and scar. Second: to establish attainable functional goals for patients with glottal incompetence and scar. Third: to set up discharge criteria and when to refer for probable surgical intervention.

Jackie Gartner-Schmidt, Ph.D.
University of Pittsburgh Department of Otolaryngology
200 Lothrop Street, Suite 500
Pittsburgh, PA 15213
412-647-2112 Fax 412-647-2080
gartnerschmidtjl@upmc.edu