Voice therapy goals for muscle tension dysphonia

Muscle Tension Dysphonia Sean Parker Institute for the Voic

Muscle tension dysphonia (MTD) is a condition of hoarseness or other symptoms related to voice production, which occurs as a result of inappropriate use of the muscles around the larynx during speech or singing. MTD may occur on its own, called primary MTD - or as a result of another underlying disorder, called secondary MTD Workshop goals •Discuss assessment and treatment of those voice disorders that are hyperfunctional in origin; •Describe the diagnostic probe and explain its importance in voice therapy; •Explain procedural aspects of selected probes; •Generate child voice goals that are easy to operationally define and to measure. Muscle Tension Dysphonia For example, if a patient has vocal nodules, LTG 2 only would be appropriate. If the patient has Muscle Tension Dysphonia in response to a vocal cyst, both may be appropriate because you want to decrease or eliminate the MTD, but the patient may or may not be a surgical candidate for the cyst to be removed, so that disorder would remain existing Practice voice techniques frequently and in conversation to make them more automatic Keep in mind, the techniques described here are meant to help compensate for voice symptoms, not to cure a neurological disorder like spasmodic dysphonia or tremor. They can resolve muscle tension dysphonia when done correctly with a voice therapis Purpose The aim of this study was to test the hypothesis that stretch-and-flow voice therapy (SnF) is noninferior to resonant voice therapy (RVT) for speakers with muscle tension dysphonia. Method Participants with primary muscle tension dysphonia were randomly assigned to 1 of 2 treatment groups. P

Muscle tension dysphonia can make your voice sound strained or hoarse and can make it uncomfortable to talk. It is common to experience muscle tension dysphonia along with another voice problem. Muscle tension dysphonia can happen when you've been sick and developed a vocal cord injury, such as laryngitis or swelling of the vocal cords Voice and/or speech therapy is one of the management options for people with spasmodic dysphonia. It can be used alone or in conjunction with treatments such as botulinum toxin injections or pre/post-surgical intervention. Voice therapy can also help with differential diagnosis as there are other voice disorders that sound similar to SD Treatment for Muscle Tension Dysphonia Muscle tension dysphonia (MTD) occurs when the muscles around the voice box are constricted during speech production. A person may work very hard to get the voice out or use too much muscle tension, sometimes without even noticing it. MTD is a voice disorder related to how the voice is used

The Short Term goals are mostly appropriate for each patient, depending on if the patient has water intake restrictions. Short Term. (1) Patient/Client will demonstrate an understanding of voice production physiology and controlled voice utilization by describing/listing the phonation process and alternatives or modifications of current use in. Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients. Journal of Speech, Language, and Hearing Research, 62, 4062-4079

The goal of voice therapy is to decrease excessive or inappropriately placed tension so that the vocal muscles can function effectively again Muscle Tension Dysphonia. The term muscle tension dysphonia (MTD) is a general term for an inconsistency in the coordination of the muscles and breathing patterns needed to create voice. This inconsistency can be seen without any structural abnormality (primary MTD) or in the presence of a structural abnormality (secondary MTD) Combined Functional Voice Therapy in Singers With Muscle Tension Dysphonia in Singing Combined functional voice therapy proved to be an efficacious treatment method in singers with MTD in singing. Development of palpation and perceptual singing voice examination protocols enables one to compare results before and after rehabilitation in clinics Treatment for muscle tension dysphonia primarily includes voice therapy with a speech-language pathologist to reduce throat tension and maximize vocal efficiency. You may be asked to pursue treatments that aid in tension release, such as massage, acupuncture, psychotherapy or physical therapy, at the same time you are receiving voice therapy

those who get good medical treatment and follow-up Speech and Language Therapy input. A positive and motivated disposition prior to, and following the diagnosis of dysarthria, and having good support systems in the form of family and friends usually provides the basis for a better prognosis. Dysphonia and Speech-Language Pathologist (SLP) to developing a comprehensive treatment plan. What is Muscle Tension Dysphonia (MTD)? MTD is a change in the sound or the feel of the voice due to excessive muscle tension in and around the voice box. This tension prevents the voic e from working efficiently. MTD is a pattern of muscle use that can develop. Common Voice Disorders mtd treatment sequence. Teaching points: Voice Therapy is the primary management strategy for muscle tension dysphonia. While a diagnosis of MTD is made more likely with an immediate positive response to voice therapy probes, as in the case above, a diagnosis of MTD should not be excluded based on lack of improvement from a single trial session of voice therapy The goal of voice therapy is to decrease excessive or inappropriately placed laryngeal tension so that the vocal muscles can function effectively again Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients. Journal of Speech, Language, and Hearing Research , 62(11), 4062-4079

Muscle tension dysphonia (MTD) is the technical term for stressful or strenuous overuse of the voice, resulting in vocal dysfunction. Over time, untreated MTD results in worsening of symptoms, including loss of vocal range and pain when singing/performing Jimmie talks about her muscle tension dysphonia diagnosis and what treatments helped her. She demonstrates one resonant voice therapy exercise and we also ge.. Muscle tension dysphonia is often found in those who require to use their voice a lot at work, such as teachers, singers and other professions where there is a high demand for voice use throughout the day. Muscle tension dysphonia may make the voice sound weak, hoarse, breathy, strained, tense or rough

Voice Speech Therapy Sydney - Trudy Lynch Speech Pathology

But What About Voice Rehabilitation Goals? Part 2: Long

Muscle Tension Dysphonia is a voice disorder characterized by strained, effortful phonation usually causing vocal fatigue if used extensively.Two types are known: Primary muscle tension dysphonia - a type of vocalizing or speaking in which the muscles in the neck are tense and when no other lesion or paralysis is seen Bonus Tip: Muscle Tension Dysphonia Treatment Massage. Muscle tension dysphonia massage is a very popular and common approach to therapy of MTD. The goal is to reduce tension from the superficial laryngeal muscles, which in turn reduces tension from the muscles inside your larynx Laryngeal manual therapy: A preliminary study to examine its treatment effects in the management of muscle tension dysphonia. Journal of Voice , 23 , 353-366. Google Schola

Intervention Outcomes of Two Treatments for Muscle Tension

Muscle Tension Dysphonia Voice Strain Duke Healt

Vocal hyperfunction/muscle tension dysphonia is diagnosed often by laryngovideostroboscopy, a non-invasive procedure to examine your vocal fold vibration and vocal fold closure. Treatment. The preferred treatment method is voice therapy. Voice therapy is much like physical therapy for any other part of the body. Sessions usually take place. And stress can manifest itself as muscle tension; specifically for our clients, vocal muscle tension, hoarseness, pain, or even loss of voice altogether. I've had clients whose muscle tension dysphonia was so severe, they were forced to take a leave of absence from their jobs. And stress was often reported as a key factor Sielska-Badurek E, Osuch-Wojcikiewicz E, Sobol M, et al. (2017) Combined functional voice therapy in singers with muscle tension dysphonia in singing. J Voice 31: 509-517. Link: https://goo.gl/QkqE4E; Craig J, Tomlinson C, Stevens K, et al. (2015) Combining voice therapy and physical therapy: a novel approach to treating muscle tension dysphonia Objectives. The purpose of this study was to evaluate vocal tract function and the voice quality in singers with muscle tension dysphonia (MTD) after undergoing combined functional voice therapy of the singing voice Telepractice Versus In-Person Delivery Of Voice Therapy For Primary Muscle Tension Dysphonia. By: Balaji Rangarathnam, Gary H. McCullough, Hylan Pickett, Richard I. Zraick, Ozlem Tulunay-Ugur, and Kimberly C. McCullough. Abstract Purpose: The purpose of this study was to investigate the utility of telepractice for deliverin

NB: It is always recommended that you consult a qualified speech-language pathologist for assessment and appropriate advice before embarking on any voice therapy program. Several of the symptoms listed above can have an underlying organic cause (e.g. vocal nodules, polyps).It's important to rule out any possible organic difficulties that may require different treatments (e.g. medication. Muscle tension dysphonia is a condition wherein the feel or the sound in your voice has changed and the primary cause is the tension in the muscle near your voice box. The muscle tension is preventing your voice to work properly. The most common treatment of this disorder is the involvement of voice therapy Certified and licensed SLPs play a central role in patient education and are critical providers of voice therapy, which addresses the behavioral and muscular issues contributing to dysphonia. Voice therapy is effective for dysphonia across the life span from children to older adults. 11,12,303,306-309 However, children <2 years old may not be. The goals of any voice therapy program are to return the voice to normal or as near normal sounding as possible. Voice therapy is usually short term, 4-10 sessions, over a 6-8 week period. Length of therapy is determined by diagnosis, the condition of the vocal folds, vocal habits, motivation and compliance with the therapeutic program Voice disorders are a range of conditions which affect the larynx. They can cause changes to the voice called dysphonia or loss of voice aphonia. These changes can affect the way the voice sounds, for example, making it sound hoarse, croaky, strained, breathy or weak. Voice disorders can also make the throat feel different, for example it might.

PPT - Functional Dysphonia/ Muscle Tension Dysphonia (MTD

Natural Treatment For Muscle Tension Dysphonia Voice Repai

  1. Voice Therapy. Whether you use your voice professionally or not, voice therapy can play an essential role in restoring and strengthening your voice. Duke Voice Care offers comprehensive voice therapy at locations in Durham and Raleigh. We are one of the few programs in the Southeast with a team of skilled voice specialists who have the advanced.
  2. Physical therapy should be prescribed when the speech and voice evaluation suggests that numerous muscle groups are tensing during phonation.26Jones et a1 reported on a patient with mus- cular tension dysphonia who was treated with voice therapy and physical therapy for a disorder that was severe enough to cause the patient to leave her job
  3. Thank you for the A2A. If you had partial vocal cord paralysis on one side, speech therapy would most likely be helping. I had this problem with my right vocal cord after my thyroid was taken out. My right vocal cord was on that fine line of pares..
  4. Treatment includes voice therapy, vocal function exercises, training in proper vocal hygiene and acid reflux precautions. We provide therapy for conditions that include: Nodules, polyps or cysts (lesions or benign growths) Paralysis (vocal nerve damage) Paresis (muscle weakness) Hemorrhage (bleeding) Muscle tension dysphonia (swelling of vocal.

But What About Voice Rehabilitation Goals? Part 1: Short

  1. A Voice Therapy Program in Muscle Tension Dysphonia Folia Phoniatr Logop 2017;69:239-245 241 DOI: 10.1159/000487942 27]. The voice signal was acquired using the voice quality modul
  2. There are several conditions that affect the voice, including the following: Muscle tension dysphonia (MTD): One of the most common voice disorders, MTD is due to an abnormal pattern of muscle activation. Vocal cord paralysis: There are many causes for this paralysis, including nerve damage from surgery, infection or certain cancers
  3. Muscle Tension Dysphonia (MTD) Treating Pain, Strain, and Changes in Voice Function . In a previous post I discussed the production of the voice by the coordination of three different systems (see post here).These include the breath, the vocal folds, and the vocal tract (everything above the vocal folds including the throat, nose, and mouth)

Using the latest techniques and therapies, we effectively treat less common voice problems such as spasmodic dysphonia, essential voice tremor, muscle tension dysphonia, aging voice, and throat cancer and voice box cancer. We also offer surgical options to improve vocal quality if you have vocal cord paralysis Physical therapy helps ease vocal muscle imbalances. Nov. 13, 2014, 9:19 AM. Carey Tomlinson, P.T., MPT, works with muscle tension dysphonia patient Peter Vogl at the Vanderbilt Dayani Center. (photo by John Russell) For singers who suddenly can't hit their high notes or call center workers who develop pain while speaking, physical therapy. Although LD and muscle tension dysphonia are considered separate disorders, it can be difficult to tell them apart, even for experts. Some experts believe that symptoms of LD and muscle tension dysphonia can co-occur. However, unlike LD, muscle tension dysphonia is reversible with voice therapy The overall aim of voice therapy is to achieve the best possible voice through guided change in vocal behaviours and lifestyle factors. . Southern Sydney Voice Therapy offers a range of voice therapy techniques that are selected based on the latest research evidence as well as our clients' personal goals and vocal needs Jun 7, 2018 - Explore Nilda Scrivner's board Dysphonia on Pinterest. See more ideas about voice therapy, speech therapy, the voice

Voice Disorders - ASH

Specializing in Spasmodic Dysphonia Treatment. Our voice is our second face; unseen, we are judged by our voices. SPASMODIC DYSPHONIA strips us of the natural flow of voicing, but it can be regained or significantly improved in the majority of cases. Having experienced this, Connie Pike has made it her mission to help as many as possible. There are a few types of hands-on work that voice SLPs have traditionally used, including circumlaryngeal massage + digital manipulation. These target the laryngeal area to reduce tension, and use movement to manipulate the areas. ⠀ ⠀ A slightly different approach...⠀ ⠀ I first learned about @waltfritzpt manual therapy style, Foundations in Myofascial Release (now Manual Therapy) at. Vocal Massage. However, one of the approaches that is used for treatment of muscle tension dysphonia is vocal massage. Vocal massage is a specific technique, during which a trained therapist uses manipulations and manoeuvres to release muscle tension from the muscles of the head and neck with the goal of improving or restoring vocal function Forgive this angry, ranting post. I've been dealing with muscle tension dysphonia for about 19 months now and I'm at my wit's end. I've been to 3 different SLPs and the speech therapy has been different flavors of the same nothing. All they have me do is hum, massage my own throat, and blow bubbles in cups of water

Voice therapy for functional voice disorders including muscle tension dysphonia, functional aphonia, and vocal fatigue Neurogenic voice disorders (vocal fold paralysis, vocal fold paresis) Pre- and post-operative voice therapy Respiratory re-training for paradoxical vocal fold movement (PVFM) also called vocal cord dysfunction (VCD), and. Myofascial Release and Muscle Tension Dysphonia (MTD) Muscle Tension Dysphonia is a voice disorder which occurs when the muscles around the voice box are so tight that the quality and volume of the voice are impaired. This condition can be the result of illness (laryngitis) overuse, stress or other conditions Trans women having varying voice goals and may choose to use feminine communication patterns all of the time or situationally.[1,17] The decreased perception of femininity over time, mentioned above, and the variable application of feminine voice may indicate the place for a maintenance program following voice therapy

Muscle tension dysphonia (MTD) was originally coined in 1983 by Morrison and describes a dysphonia caused by increased muscle tension of the muscles surrounding the voice box: the laryngeal and paralaryngeal muscles. MTD is a unifying diagnosis for a previously poorly categorized disease process. It allows for the diagnosis of dysphonia caused by many different etiologies and can be confirmed. Orlando Stuttering Therapy: Progression Speech Therapy is a private practice based in Orlando, Florida. We offer individual speech therapy sessions, both in person and by teletherapy and provide the most cutting edge and progressive approaches to meet your goals Resonant voice therapy progresses from feeling these oral sensations in basic speech gestures (e.g. ma, me, moo) through to sentence level and then conversational speech. The goal is to achieve the strongest, smoothest and clearest voice possible with the least effort and impact between the vocal cords to minimize the likelihood of injury. Muscle Tension Dysphonia..... 16 Paradoxical Vocal Cord Movement voice therapy programs also include (3) Stress counseling, if relevant. Specific ap-proaches to hygiene, voice production, and stress counseling are described in Part 2 o

Voice Therapy in Muscle Tension Dysphonia - ME-OT

This systematic review investigated the effects of voice therapy for adults with muscle tension dysphonia. Questions/Aims Addressed To systematically review the effects of voice therapy on subjects diagnosed with [muscle tension dysphonia] or hyperfunctional dysphonia, as well as assess the uniformity of evidence on this voice disorder (p A 45-year-old female patient with muscle tension dysphonia (MTD) was treated by voice therapy with successful results. This case exhibited strained hoarseness in free conversation. Endoscopic laryngeal examination showed hyperadduction of the false vocal cords and anterior-to-posterior compression of the arytenoid cartilages toward the petiole. BASTIAN VOICE INSTITUTE DOWNERS GROVE, IL A Seminar for All Voice Professionals Muscle Tension Dysphonia and Related Voice Problems: Audience targeted, learning goals and outcomes: 3010 Highland Parkway, Suite 550 Downers Grove, IL 60515 Course Description: MTD, a common voice disorder, is often overlooked, misdiagnosed, or incorrectly treated Fig4.Primary muscle tension dysphonia (before & after voice therapy), laryngoscopic view . Fig5. Vocal cord nodule (before & after voice therapy), laryngoscopic view . 4 DISCUSSIONS . In the literature, there are few reports of efficacy of voice ther-apy which shows 1 evidencelevel [21]. Voice therapy doesn't only involve the behavioral voice. The risk of developing a voice disorder is 30%. 1 Voice disorders cost approximately $2.5 billion in lost wages, physicians' visits, and treatment expenses. 1 Muscle tension dysphonia (MTD) is a common voice disorder characterized by an excess of muscular recruitment during voice production. 2 In normal voice production, expiratory airflow.

• Van Houtte E et al. (2009) Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice 25(2): 202-207 • Ruotsalainen J et al. (2008). Systematic review of the treatment of functional dysphonia and prevention of voice disorders. Oto Head Neck Surg 138: 557-56 Voice exercises help to relieve symptoms of muscle tension dysphonia (MTD), a voice disorder The Speech Therapy Departm ent at Singapore General Hospital , a member of the SingHealth group, shares symptoms of muscle tension dysphonia (MTD) and gives tips to maintain a healthy voice. Muscle tension dysphonia (MTD) is a voice disorder characterised by strain and effort when talking Occasionally, muscle tension dysphonia may develop in an attempt to use a hoarse, weak voice during or following an upper respiratory infection. Voice therapy is usually the treatment of choice coupled with identification of any underlying medical condition that may be exacerbating the problem. Vocal Fold Granuloma-is an inflammatory growth. It.

Secondary muscle tension dysphonia occurs when you overcompensate for underlying issues. For example, you have a nodule on your vocal cord so you use more force when speaking or singing. Voice therapy is highly recommended to treat muscle tension dysphonia Muscle Tension Dysphonia - I've lost my Voice! It was a bit of a joke back in April at the start of lockdown when I lost my voice. I think it was the combination of a virus and the whole stress of the lockdown been announced Sometimes : It can. A well qualified speech therapist should be able to treat dysphonia getting at least a partial response without resorting to Botox injections. Ask U.S. doctors your own question and get educational, text answers — it's anonymous and free! Doctors typically provide answers within 24 hours Muscle tension dysphonia (MTD). We all learned about it in grad school. Textbooks and lectures described such muscle tension as being severe enough to cause aphonia. Treatment advice suggested getting your hands on the larynx and providing circumferential massage to chill those muscles out. I recall even watching some video of a patient talking, with [

Muscle Tension Dysphonia Speech Therapy & Language

Combined Functional Voice Therapy in Singers With Muscle

Most credible teachers of singing these days have knowledge of several classical and popular styles, and I would be interested in what her college teacher says. Ideally, she would see an otolaryngologist (not an ENT) who specialized in voice disorders, because Muscle Tension Dysphonia always is the result of something gone awry, not a cause A place for people affected by voice disorders mission muscle tension muscle tension dysphonia myasthenia gravis myofascial release neurogenic voice disorder occupation personal stories psychogenic voice disorder psychologist psychosocial support Rachael Cunningham research self care singing spasmodic dysphonia speech therapy structural.

Muscle Tension Dysphonia Johns Hopkins Medicin

These voice disorders include benign vocal fold lesions on vocal cords (commonly called vocal cord nodules) and vocal deterioration in the absence of diagnosable pathology (commonly called muscle tension dysphonia). Scientific Premise. Multiple factors are believed to cause and maintain the disorders linked to VH. The most important mechanisms. Participants with primary muscle tension dysphonia were randomly assigned to experimental or control groups. Experimental participants received vocal hygiene education followed by 6 weeks of stretch‐and‐flow voice therapy. Control participants received vocal hygiene education only However over the past decade there has been an increase in evidence to show that there is efficacy for the use of manual therapy of the laryngeal and perilaryngeal (around the larynx) area for Muscle Tension Dysphonia (MTD). So lets talk about Muscle Tension Dysphonia. What is it?? MTD is a common disorder of the voice where there is excessive.

Muscle Tension Dysphonia (MTD) is the most common voice disorder. It occurs when a person habitually uses a dysfunctional muscular pattern to produce voice in the absence of structural or neurological pathology. Overtime, the excessive muscular force and physical effort that is used can lead to the development of benign vocal fold lesions such. Read about Dysphonia Types, Symptoms, Causes, Treatment. Muscle tension dysphonia, functional dysphonia and spasmodic dysphonia. dysphonia vs dysarthria. The generation of voice requires a sound producing system called as phonatory system, a control center and a network connecting the two. Phonatory system includes voice box and vocal cord Reinke's edema, also called polypoid corditis, is a swelling of the entire layer of the superficial lamina propria (or Reinke's layer), a structure crucial to normal voice function. It occurs almost exclusively in smokers. Reinke's edema involves the left vocal fold above, making it appear very swollen Muscle tension dysphonia involves problems with the muscles around the vocal cords and in the throat. In addition, the medical professional may recommend that the patient see a speech therapist . Undergoing speech therapy can address the vocal habits that helped to develop the dysphonia initially, and help retrain the individual to make use of. Hancock R. Management of functional aphonia and related severe muscle tension disorders: a practical approach with historical underpinnings. Perspect Voice Voice Disord. 2014;24(2):55-63. 10. Mathieson L. The evidence for laryngeal manual therapies in the treatment of muscle tension dysphonia

Muscle Tension Dysphonia: Physiotherapy May Help Ease

An interprofessional team collaborated across specialties to diagnose a 20-year-old college student with muscle tension dysphonia and paradoxical vocal cord dysfunction. After the student returned to college, the initial team worked with a local speech-language pathologist (SLP) and with a college voice coach to continue her treatment A severe voice disorder can also interfere with the social functions of language. An extreme voice disorder, such as advanced spasmodic dysphonia, usually has severe vocal symptoms associated with it. The ability of an individual with spasmodic dysphonia to function in the world can be compromised considerably Muscle tension dysphonia (MTD) is one of the most common voice disorders. It has classically been divided into primary and secondary types. Primary MTD, the focus of this presentation, is best defined as a multifactorial voice disturbance in the absence of structural or neurologic abnormalities. MTD, often a diagnosis of exclusion, is known by. 785-233-0500 | Muscle tension dysphonia (MTD) occurs when there is excessive muscle tension in the larynx, leading to hoarseness as well as tenderness of the throat. What Are the Symptoms of MTD? Other common symptoms of MTD include: Vocal strain. Pitch changes. Pain & discomfort in the throat. Voice fatigue. What Cause The goal of transgender voice therapy is unique for every individual. Some common targets of voice training are to achieve a more feminine, masculine or gender-neutral voice quality. At the beginning of treatment with a new client, we will establish goals and create a plan for achieving these goals. Muscle tension dysphonia. Spasmodic.

Stuttering Therapy in Orlando | Individualized Speech Therapy

Listen to their voice in normal conversation. Listen and watch for muscle tension in neck and face, paralysis or tremors, inadequate mouth opening, excessive loudness of voicing or not enough loudness of voicing, excessive speaking, frequent throat clearing/coughing, clavicular breathing. Visipitch software to assess acoustics of voice By your Speech Pathologist: Gal Levy . MTD - Muscle Tension Dysphonia. Dear Doctor / Colleague, This letter will shed some light on: M T D A common cause of voice problems is abnormal patterns of. Functional Dysphonia/ Muscle Tension Dysphonia: Pediatric Implications By: Bridget Russell, PhD, CCC-SLP Functional Dysphonia (FD) is a voice disorder that presents with vocal quality aberrations including aphonia, strain, and/or severe dysphonia with no presence of structural abnormality of the vocal folds or the existence of benign organic lesions Laryngeal muscle tension disorder is the general term given to describe a variety of conditions that can cause both voice and breathing problems. When the voice is primarily affected, these disorders are also called muscle tension dysphonia. This page provides more information on how laryngeal muscle tension dysphonia can affect the voice A dysphonia (diss-PHONE-nee-ah) is the medical term for a voice disorder. Muscle tension dysphonia (MTD) is one of the most common voice disorders. It occurs when the muscles around the larynx (voice box) are so tight during speaking that the voice box does not work efficiently. MTD is more prevalent among people in the 40- to 50-year-old age. Our final video upload from the recent 'Dysphonia~let's talk about it' forum, provides an overview of laryngeal massage, a complementary therapy approach to managing voice disorders. Rachael Cunningham is an accomplished Opera Singer and a specialised myofascial massage therapist. The founder of Vocalease Massage in Sydney, Rachael works alongside laryngologists and speech therapists to.