Intervention
Achieve optimal laryngeal posture, improve impedance match at level of vfs, coordinate respiratory/phonotory systems, reduce muscle tension, reduce vocal effort or increase vocal effort, massage laryngeal tissue in some SOVT exercises
What are goals of SOVT?
Muscle tension dysphonia (MTD) and benign vocal fold lesions
Voice feminization: articulation
More precise articulation, precise and light
OR based surgery that utilizes small, delicate surgical instrumentation, performed with maximum control via high-powered machine for optimal results
Microlaryngeal/phono surgery
An intervention option that involves injection laryngoplasty, used to bulk up vocal folds
What is vocal fold augmentation/medialization?
Improve oral resonance, coordinate respiration, phonation, and resonance, establish healthy and non-phonotraumatic voice production
What are goals of Resonant Voice Therapy? (RVT)
Name the goals of CTT
Improve oral resonance, coordinate respiration, phonation, and resonance, establish target voice production in context immediately
Voice feminization: inflection
Upward gliding intonations, more frequent inflections
No need for IV medication or cardiopulmonary monitoring, involves endoscopy, tracheobronchoscopy, and esophagoscopy
Office-based laryngeal surgery
What problems might vocal fold augmentation solve?
Glottal insufficiency- vf paralysis/paresis, vf atrophy, vf scarring
Focuses on the airflow and the balance between airflow and phonation in sound production; biofeedback
What is flow phonation?
Global cue for CTT
Clear speech; over-exaggerated articulation, clear/crisp consonants
Factors that might impact voice masculinization
Testosterone use, binder use
Advantages of office based laryngeal surgery
Laryngeal signs in presbyphonia
Bowing of vfs, prominent arytenoid cartilage vocal processes, asymmetry of vf vibration, predominant open phase, compensatory hyperfunction
Improve glottic closure, strengthen laryngeal musculature, improve overall intelligibility, reduce risk of phonotrauma
What are goals of increased vocal effort?
What is negative practice?
Empowers the patient to learn that they are in the driver’s seat when it comes to voice production.
Have the patient practice speaking in their new “clear speech”.
Stop them and ask them to speak in the voice that they initially came to the clinic complaining about.
Have the switch back and forth between the new voice and the old voice while conversing.
Voice masculinization: resonance
Increase length and openness of vocal tract
Disadvantages to office-based laryngeal surgery
Possible barrier regarding reinbursement, airway obstruction, esophageal perforation, laryngospasm, bleeding, nosebleeds, nausea/vomiting
Inappropriate adduction of the vfs during breathing
Paradoxical fold motion (PVFM)
Vocal fold atrophy or presbyphonia
What is PhoRTE used for?
Clear speech, rapport building, auditory/kinesthetic awareness, negative practice/labeling, embedded resonant voice basic training gesture, prosody/pauses/projection
Gender affirming voice care should be
Healthy and sustainable
Microlaryngeal surgery advantages
Often elective, improves vocal function, involves post-op therapy, no major dietary restrictions
Etiologies of PVFM
Psychogenic, visceral, neurological