The Role of Voice Therapy in Treating Symptoms of Laryngopharyngeal Reflux

  • Barbara EbersoleEmail author
  • Liane McCarroll


Voice therapy is an effective adjunct to the medical treatment of laryngopharyngeal reflux and its sequelae, including dysphonia. This chapter discusses the role of the speech-language pathologist in treating symptoms of laryngopharyngeal reflux. This is accomplished by reviewing the indications for and general principles of voice therapy in this population. An overview of the speech-language pathologist assessment and basic therapeutic approaches is provided. The authors review specific components of the speech-language pathologist evaluation such as the value of laryngeal visualization, objective and subjective measures, and stimulability testing. Functional contributors to symptoms such as vocal subsystem imbalance, supraglottic hyperfunction, extra-laryngeal muscle tension, degree of voice demand, and vocal hygiene are also discussed. Direct and indirect therapy techniques and typical therapy goals are described. Finally, specific laryngopharyngeal reflux-related laryngeal pathologies and their associated symptoms are detailed from the management standpoint of the speech-language pathologist. These include laryngitis, vocal process granuloma, vocal cord dysfunction, paradoxical vocal fold motion, chronic cough, laryngospasm, benign vocal fold lesions, and muscle tension dysphonia.


Dysphonia Speech-language pathologist Voice therapy Laryngopharyngeal reflux Stimulability testing Direct therapy Indirect therapy Laryngitis Vocal process granuloma Vocal cord dysfunction Paradoxical vocal fold motion Chronic cough Laryngospasm Benign vocal fold lesions Muscle tension dysphonia 


  1. 1.
    Garcia Martins RH, Do Amaral HA, Mendes Tavares EL, Garcia Martins M, Goncalves TM, Dias NH. Voice disorders: Etiology and diagnosis. J Voice. 2016;30(6):761.e1–9.CrossRefGoogle Scholar
  2. 2.
    Delahunty JE. Acid laryngitis. J Laryngol Otol. 1972;86:335–41.CrossRefGoogle Scholar
  3. 3.
    Joshi AA, Chiplunkar BG, Bradoo RA. Assessment of treatment response in patients with laryngopharyngeal reflux. Indian J Otolaryngol Head Neck Surg. 2017;69(1):77–80.CrossRefGoogle Scholar
  4. 4.
    Park JO, Shim MR, Hwang YS, Cho KJ, Joo YH, Cho JH, Nam IC, Kim MS, Sun D. Combination of voice therapy and antireflux therapy rapidly recovers voice related symptoms in laryngopharyngeal reflux patients. Otolaryngol Head Neck Surg. 2012;146(1):92–7.CrossRefGoogle Scholar
  5. 5.
    Vashani K, Murugesh M, Hattiangadi G, Gore G, Keer V, Ramesh VS, Sandur V, Bhatia SJ. Effectiveness of voice therapy in reflux-related voice disorders. Dis Esophagus. 2009;23:27–32.CrossRefGoogle Scholar
  6. 6.
    Chang JI, Bevans SE, Schwartz SR. Evidence-based practice: management of hoarseness/dysphonia. Otolaryngol Clin North Am. 2012;45:1109–26.CrossRefGoogle Scholar
  7. 7.
    Sapienza C, Hoffman Ruddy B. Voice disorders. San Diego: Plural Publishing; 2009.Google Scholar
  8. 8.
    West R, Kennedy L, Carr A. The rehabilitation of speech: a textbook of diagnostic and correct procedures. NY: Harpers and Bros; 1937a.Google Scholar
  9. 9.
    Kempster GB, Gerratt BR, Verdolini Abbott K, Barkmeier-Kramer J, Hillman RE. Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol. Am J Speech Lang Pathol. 2009;18:124–32.CrossRefGoogle Scholar
  10. 10.
    Karnell MO, Melton SD, Childes JN, Coleman TC, Dailey SA, Hoffman HT. Reliability of clinician based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders. J Voice. 2007;21(5):576–90.CrossRefGoogle Scholar
  11. 11.
    Ebersole B, Soni R, Lango M, Moran K, Jamal N. The role of occupational voice demand and patient-rated impairment in predicting voice therapy adherence. J Voice. 2017; pii: S0892-1997(17)30162-5. [Epub ahead of print].CrossRefGoogle Scholar
  12. 12.
    Gartner-Schmidt JL, Roth DF, Zullo TG, Rosen CA. Quantifying component parts of indirect and direct voice therapy related to different voice disorders. J Voice. 2013;27(2):210–6.CrossRefGoogle Scholar
  13. 13.
    Ylitalo R, Hammarberg B. Voice characteristics, effects of voice therapy, and long-term follow-up of contact granuloma patients. J Voice. 2000;14(4):557–66.CrossRefGoogle Scholar
  14. 14.
    American Academy of Otolaryngology-Head and Neck Surgery Committee on Speech, Voice, and Swallowing and the Special Interest Division 3, Voice and Voice Disorders of the American Speech-Language-Hearing Association. 2005.Voice therapy in the treatment of dysphonia.Google Scholar
  15. 15.
    Murray T, Sapienza C. The role of voice therapy in the management of paradoxical vocal fold motion, chronic cough, and laryngospasm. Otolaryngol Clin North Am. 2010;43:73–83.CrossRefGoogle Scholar
  16. 16.
    Soni R, Ebersole B, Jamal N. Treatment of chronic cough: single institution experience utilizing behavioral therapy. Otolaryngol Head Neck Surg. 2017;156(1):103–8.CrossRefGoogle Scholar
  17. 17.
    Lee BE, Kim GH. Globus pharyngeus, a review of its etiology, diagnosis, and treatment. World J Gastroenterol. 2012;18(20):2462–71.CrossRefGoogle Scholar
  18. 18.
    Khalil HS, Reddy VM, Bos-Clark M, Dowlry A, Pierce MH, Morris CP, Jones AE. Speech therapy in the treatment of globus pharyngeus: how we do it. Clin Otolaryngol. 2012;36:371–92.Google Scholar
  19. 19.
    Karkos PD, George M, Van Der Veen J, Atkinson H, Dwivedi RC, Kim D, Repanos C. Vocal process granulomas: a systematic review of treatment. Ann Otol Rhinol Laryngol. 2014;123(5):314–20.CrossRefGoogle Scholar
  20. 20.
    Leonard R, Kendall K. Effects of voice therapy on vocal process granuloma: a phonoscopic approach. Am J Otolaryngol. 2005;26:101–7.CrossRefGoogle Scholar
  21. 21.
    Ryan NM, Vertigan AE, Bone S, Gibson PG. Cough reflex sensitivity improves with speech language pathology management of refractory chronic cough. Cough. 2010;6:5.CrossRefGoogle Scholar
  22. 22.
    Matrka L. Paradoxic vocal fold movement disorder. Otolaryngol Clin North Am. 2014;47:135–46.CrossRefGoogle Scholar
  23. 23.
    Vertigan AE, Gibson PG. The role of speech pathology in the management of patients with chronic refractory cough. Lung. 2012;190:35–40.CrossRefGoogle Scholar
  24. 24.
    Murray T, Tabaee A, Aviv JE. Respiratory retraining of refractory cough and laryngopharyngeal reflux in patients with paradoxical vocal fold movement disorder. Laryngoscope. 2004;114:1341–5.CrossRefGoogle Scholar
  25. 25.
    Tang SS, Thibeault SL. Timing of voice therapy: a primary investigation of voice outcomes for surgical benign vocal fold lesion patients. J Voice. 2015;31(1):129.e1–7.CrossRefGoogle Scholar
  26. 26.
    Da Cunha Pereira G, De Oliveira Lemos I, Dalbasco Gadenz C, Cassol M. Effects of voice therapy on muscle tension dysphonia: a systematic literature review. J Voice. in press. 2018;32(5):546–52. Scholar
  27. 27.
    Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice. 1999;13(4):557–69.CrossRefGoogle Scholar
  28. 28.
    Rosen CA, Lees SA, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope. 2004;114:1549–56.CrossRefGoogle Scholar
  29. 29.
    Arffa RE, Krishna P, Gartner-Schmidt JL, Rosen CA. Normative values for the voice handicap index-10. J Voice. 2001;26(4):462–5.CrossRefGoogle Scholar
  30. 30.
    Nanjundeswaran C, Jacobson BH, Gartner-Schmidt JL, Verdolini Abbott K. Vocal fatigue index (VFI): development and validation. J Voice. 2015;29(4):433–40.CrossRefGoogle Scholar
  31. 31.
    Schembel AC, Rosen CA, Zullo TG, Gartner-Schmidt JL. Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway. Larygoscope. 2013;123:1931–6.CrossRefGoogle Scholar
  32. 32.
    Gartner-Schmidt JL, Schembel AC, Zullo TG, Rosen CA. Development and validation of the dyspnea indez (DI): a severity index for upper airway-related dyspnea. J Voice. 2014;28(6):775–82.CrossRefGoogle Scholar
  33. 33.
    Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Speech PathologyFox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health SystemPhiladelphiaUSA

Personalised recommendations