We support people referred by an ENT (ear, nose and throat) specialist for problems with their voice or voice box (larynx).

Those referred to us will have had a recent nasendoscopy (a thin bendy camera that is passed through the nose to look at the voice box, vocal cords and muscles).

This tells us information about the likely causes of your voice problem, or dysphonia.

Dysphonia is a voice problem that changes how a person’s voice sounds. It can affect the quality, pitch, loudness, or effort of the voice. A person’s voice may sound hoarse, weak, strained, or breathy, and talking may feel harder than usual.

Causes

Dysphonia happens when the vocal cords in the larynx (voice box) do not work as they should. This can happen for many reasons, such as:

  • Using the voice too much
  • Swelling or inflammation
  • Changes in the structure of the vocal cords
  • Illness
  • Problems with the nerves that control the voice

Examples include vocal cord nodules, laryngitis, nerve problems, vocal cord injury, or muscle tension in and around the larynx.

Symptoms

  • Hoarse or rough voice
  • Weak or breathy voice
  • Strained or effortful speech
  • Changes in pitch or loss of voice
  • Tiredness or discomfort when speaking

Diagnosing dysphonia

An ENT (ear, nose and throat) doctor diagnoses dysphonia. They look at the vocal cords using a nasendoscope. This is a small flexible camera passed through the nose to look at your voice box.

If needed, the ENT doctor will refer the person to a speech and language therapist (SLT) for voice therapy. We will work together to choose the best treatment.

The SLT will ask questions about your medical history and voice changes. They may ask you to speak, read aloud or say vowel sounds to listen to any changes in your voice.

Treatment

  • Voice therapy to improve how you use your voice
  • Breathing and posture techniques
  • Good voice care, such as drinking water and avoiding throat clearing
  • Reducing strain, such as shouting or talking for long periods
  • Medical treatment in some cases, depending on the cause

Living with dysphonia

  • Speaking may feel tiring, but therapy and good voice habits can help
  • Take breaks if you talk for a long time
  • Drink plenty of water
  • Avoid whispering or shouting
  • Keep practising the exercises the SLT taught you

Supporting someone with dysphonia

  • Be patient if they need to rest their voice
  • Reduce background noise so they do not need to speak loudly
  • Encourage them to follow their voice care plan
  • Understand that long conversations may be tiring
  • Support them in attending therapy and practising exercises

Summary

Dysphonia affects how a person’s voice sounds and feels. Many people can improve their voice and reduce strain with:

  • the right therapy
  • good voice habits
  • support

We also support people with cough and breathing problems.

ENT (ear, nose and throat) consultants sometimes refer to us if you have a cough related to laryngeal hypersensitivity. Those with cough and breathing problems are referred by our Northumbria respiratory team.

This is usually people with a chronic cough. As part of the respiratory speech and language therapy service, we also see people who have trouble breathing due to inducible laryngeal obstruction (ILO).

If you have a problem with your voice, an ENT (ear, nose and throat) doctor can refer you. You must have had a recent nasendoscopy.

If you have a problem with coughing or breathing (upper airways in nature or due to hypersensitivity), a Northumbria respiratory doctor can refer you.

Assessment

We will offer you a first appointment to carry out tests to learn more about your symptoms. This will usually be at the closest outpatient department to your home. We may ask you to fill in a questionnaire.

In this first appointment, we will give you advice so you can start straight away on improving your voice quality. We will develop a therapy plan. We will involve you in all decisions about your care.

Report

We will write a report of findings and plan. We will send this to you, your GP, and anyone else involved in your care.  

Therapy

We agree on a therapy plan together. Treatment options include:

  • another outpatient appointment or a block of voice therapy. In person or by phone / online
  • a review appointment after an agreed time period
  • self-management. Some people find one appointment is enough and can manage their own symptoms. We have a patient initiated follow-up (PIFU) option. This means you can get back in touch if you need support.
  • another nasendoscopy. This will be the same procedure you had with the ENT doctor. But we will look at how your throat works during the therapy exercises.

We will explore factors that might be leading to your symptoms. The first appointment usually includes asking you about when your difficulties started and how it affects

  • your daily life and wellbeing
  • your general health and any medications you take
  • your work, hobbies and voice use
  • your daily water intake
  • any triggers for your symptoms
  • any strategies you have found that help

We will help you to:

  • Understand what leads to your dysphonia and what you can do to help
  • Find ways to improve your throat health
  • Understand how your voice box works
  • Learn key exercises to help you to have a clear voice:
    • breathing exercises
    • exercise to release tension in your neck, shoulders and throat
  • Manage your voice use in your work or general life
  • Support your wellbeing
  • Create a plan to help manage your symptoms in the future

This can vary. Some people only need one appointment, but for most it is about 4 sessions. Some people don’t need as many as this and some people need more than this.  

Unfortunately, it is not always possible to resolve your problems completely. Outcomes depend on how easy it is for you to:

  • make lifestyle changes
  • practice the exercises regularly
  • manage other factors affecting your condition

We will always aim to reduce the impact of your symptoms as much as possible. We help you to manage them as confidently as possible. We will help you to learn to manage the symptoms if they  return.

Contact number: 0191 293 3001

Voice enquiries - SLTENT@northumbria-healthcare.nhs.uk

Respiratory enquiries - SLTrespiratory@northumbria-healthcare.nhs.uk

Clinic locations

Nasendoscopy appointments

This is a specialist assessment by referral only.  

Attendance

Please let us know as soon as possible if you can't come to an appointment or no longer wish to continue with therapy.

If you miss an appointment without telling us, we will write to you to ask you to contact us within 1 month for a new appointment. If we do not hear from you, we will discharge you from the service.

Missed appointments cost the NHS money and can delay treatment to you or others on the waiting list. If you repeatedly cancel within 24 hours of your appointment within your planned treatment period, we will discharge you.

Video consultations

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We can offer online consultations where appropriate via a video call to make it easier for you to attend.

Rather than travelling to your appointment, you will receive a text or email before your appointment and simply need to click to join. Find out more here.

Adult speech and language therapy