Voice therapy for hoarseness, vocal nodules and professional voice users

What it is

Your voice is produced when the vocal folds in your larynx (voice box) vibrate as air passes through them. When something affects how the vocal folds move or how you use the muscles around them, your voice can sound hoarse, rough, breathy, weak or strained, and talking can become tiring.

Voice disorders have many causes. Some involve changes to the vocal folds, such as nodules or polyps. Others come from how the voice is used, for example speaking with too much tension (often called hyperfunction or muscle tension dysphonia). Some are linked to medical or neurological conditions. Because the causes differ, the first step is understanding what is happening.

Why a medical exam matters

A speech-language pathologist cannot see your vocal folds during a regular appointment. A physician, usually an ear, nose and throat specialist (ENT), examines the larynx with a small camera to make a diagnosis. Voice therapy is planned around that diagnosis, so in most cases we will ask that you have, or arrange, a laryngeal exam.

See a physician promptly if hoarseness lasts more than about four weeks, or sooner if you smoke, if the change was sudden, or if you have pain, trouble swallowing or breathing, a lump in your neck or you cough up blood. A sudden change in voice or speech together with weakness, facial drooping or confusion is an emergency: call 911.

Who we see

• Professional voice users, such as teachers, educators, call-centre staff, clergy, lawyers, coaches and fitness instructors.
• Singers and actors, including people whose voice changes after heavy performance schedules.
• Adults with hoarseness, vocal fatigue, nodules, polyps or muscle tension in the voice, often referred by an ENT.
• Children and teens whose voices are often hoarse, sometimes after lots of yelling at play or in sports.
• People with neurological conditions that affect the voice, such as Parkinson’s disease, alongside our dysarthria services.

How we assess it

We begin with your story: when the change started, how your voice behaves through the day and the week, how much and where you use it, and what your physician has found.

The speech-language pathologist then listens to your voice and looks at breathing, posture, tension, pitch, loudness and how your voice holds up across speaking and, if relevant, singing tasks. We may record voice samples and ask you to rate how your voice affects your daily life. These measures help us track change over time.

If you have not yet seen an ENT, we will explain why it matters and can write to your physician to share our observations. Learn more about our assessment process.

How therapy works at VoxLingue

Voice therapy is active and practical. You learn new ways of using your voice and practise them until they feel natural in real situations.

Building an easier, more efficient voice

Sessions often include gentle exercises that balance breath and voice, reduce throat tension and find a clear, easy tone. Approaches such as resonant voice work and semi-occluded vocal tract exercises (for example, phonating through a straw) are widely used and supported by research. Your clinician chooses exercises based on your diagnosis and goals.

Vocal hygiene

Small daily habits make a difference. We help you build a plan that fits your life, which may include:

• Staying well hydrated through the day.
• Reducing throat clearing and yelling, and finding other ways to get attention.
• Using amplification in classrooms or large rooms when possible.
• Planning voice breaks during long teaching or performing days.
• Discussing reflux, allergies or medication effects with your physician.

Professional voice users and singers

For people whose work depends on their voice, therapy focuses on the actual demands of the job: projecting in a classroom, a long day of calls, or a demanding rehearsal schedule. Members of our team have specific experience with voice pathology in professional singers and voice users. With your permission, we work alongside your singing teacher or vocal coach.

Working with your ENT

We share progress with your physician when you agree to it, and follow their recommendations. If your voice does not respond as expected, or new symptoms appear, we will recommend a return visit to the ENT.

Your role at home

Voice therapy works when new habits reach your daily life. Your clinician will give you short exercises to do several times a day, and ways to check in on your voice at work. For children, parents help with brief practice and with noticing yelling or strained voice in a supportive way, without criticism.

Bilingual and multilingual families

Many people in Montréal and in Ontario use more than one language through the day, and voices can behave differently from one language to another. Pitch, loudness and rhythm habits sometimes shift with the language, and some people notice more strain in one language than the other.

Our team works in English and French, and clinicians on the team speak many other languages. We look at how you use your voice in each of your languages, including at work and at home. For singers, we can consider repertoire in different languages. Availability of specific languages varies, and we will match you as closely as we can.

In person or by telepractice

You can see us in person at our Marché Central clinic in Montréal, or by telepractice anywhere in Quebec and Ontario. Many parts of voice therapy work well online with a good microphone and a quiet room. Your clinician may suggest an in-person session when a closer look at posture or tension would help.

Getting started

You do not need a physician referral to book with us. If you have not yet had a laryngeal exam, we will talk with you about arranging one with a physician, since it guides therapy.

Call our Marché Central clinic at 514-467-9132, or request an appointment through our contact form. We will discuss your voice concerns and match you with a clinician whose experience fits your needs.