What are Vocal Fold Nodules?

What are vocal fold nodules?

Vocal fold nodules develop due to trauma of the vocal folds. When you use your voice incorrectly over time, the vocal folds might become swollen. These swollen areas then become nodules that are sometimes called ‘soft nodules’ but as they progress they can be called ‘hard nodules’ and be harder to treat. They usually form a pair – opposite each other on each vocal cord. Occasionally a diagnosis of a nodule on one vocal cord is made, with only some slight swelling on the opposite vocal cord.

What causes vocal fold nodules?

Vocal fold nodules are typically caused by voice misuse. This may include shouting, screaming, singing or excessive use of voice over long periods of time.

When we use our voice ineffectively and develop habits that use too much force with our voices, this puts strain on the vocal folds. Nodules are common whose work involves using their voice for long periods of time. Typical jobs might be singers, teachers or actors.  Due to the importance of communication in these jobs, a nodule affecting the voice can have a big impact on sustaining voice throughout the day. This can be very stressful when our voices are essential to our work and income.

What are the symptoms of vocal fold nodules?

You will notice voice changes such as a gradual onset of hoarseness, breathiness and an effortful voice with breaks.

When producing normal voice, the vocal folds meet fully together. When there is a nodule, this causes a gap between the vocal folds, resulting in air escape through this gap, and a subsequently breathy voice.

You may also have a lower pitch, experience throat discomfort and throat clearing. You may additionally feel some soreness in your larynx after using your voice for long periods.

How are vocal fold nodules diagnosed?

Typically an Ear, Nose and Throat Consultant puts a camera up your nose, called an endoscopy, to gain a view of your vocal folds. They will inform you of your diagnosis in this examination.

Can vocal fold nodules go away on their own?

In the acute stages, vocal nodules may resolve with voice rest alone. However, if it is due to repetitive vocal misuse, then Voice Therapy treatment will be required. Voice Therapy is first choice rather than surgery. If surgery is required, Voice Therapy following surgery to prevent reoccurrance is recommended. Online Voice Therapy for Voice is effective for treating nodules.

Can I have Voice Therapy with the NHS?

The ENT consultant will often refer you to a NHS Voice Therapist. We see people who have seen an ENT consultant privately due to a long NHS wait, or those that are waiting for an NHS appointment but are keen to get started due to the impact on their income.

Our UK based Private Voice Therapists are Clinical Specialists in Voice with a minimum of 15 years experience Specialising in Voice Therapy. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.

Can you fix a lisp when you an Adult?

Lisping is very common within adults, with varying levels of severity. Some adults who lisp are very self-conscious about it and it affects their self-esteem and confidence to speak, and impacts on their day to day life. They may place themselves under a great deal of pressure to avoid words involving /s/ and /z/ and may even avoid talking because of it. Many adults are keen to correct their speech in order to feel more confident when speaking both socially and in the workplace.

Every adult is different, and the process of therapy varies from person to person. Whilst some clients only attend a couple of sessions with an experienced Speech Therapist to learn about how to make the /s/ and /z/ sounds, others attend more sessions in order to generalize their /s/ and /z/ into their everyday speech. The initial session will inform us whether the lisp is due to your anatomy and in some instances, we may need to signpost you to other services for further investigation. Sessions cost 90 per session and most people book 1-3 sessions.

Here we share a personal experience of one of our clients in her 50s; of the impact of the lisp and their experience of therapy:

“Speech and Language Therapy might be seen as a luxury but it really shouldn't be because it's a necessity for many people like me. Communication isn't just about uttering words, but a person's ability to make others hear them and understand them. When you struggle with a lisp problem, even though you know what to say, you don't always have the confidence to speak up. As a child, I never put my hand up in school even though I had the answers because I was afraid the other children would make fun of me, which they did whenever they could to hurt my feelings. I avoided arguing with my siblings because whenever I was right, they'd resort to mimicking my lisp as a way to shut me up. I was a very bright student but I purposely sabotaged myself at some point in High School because teachers wanted me to take the lead too often, and I couldn't face people with my lisp. When it came to choosing my career path, I chose a path where I thought that people wouldn't make fun of me because of the way I pronounce my sss and zzs.

Character and personality always play a central role in personal development. Some people may be fine with a lisp and some others not. If you're someone who is uncomfortable with your lisp, then I recommend that if you're able to afford the cost, you should really reach out to the Speech Network. Alison, my therapist, has given me more than just confidence. She has also given me mind comfort - a safe place where I could simply try and see if I could speak differently. For me, it's really that - a safe place for both my mind and body to feel free to give it a try. So I gave it a try, and now, I can speak and enjoy what I sound like, and most importantly, looking at myself in the mirror, I like the way my face looks when I'm talking and my tongue remains in my mouth when I pronounce S and Z. I'm bilingual so I have to work on both languages at the same time, and I'm truly enjoying the process.”

Click on the contact us button to email or book a free consultation. We are happy to email fees on request.

Is Stuttering caused by Anxiety ?

Anxiety is a feeling of unease, such as a worry or fear that can be mild or severe. Everyone can feel anxious in situations such as giving presentations, an oral exam or going for an interview. These anxious feelings are normal. Anxiety is not always ‘bad’. It can make us feel uncomfortable but it is also a really important function - we should feel anxious when we have an exam coming up as anxiety motivates us to study. Anxiety motivates us to prepare and take action. It is sometimes confused with excitement. Anxiety becomes difficult when it stops allowing you to do the things you enjoy in life and affects you everyday.

In the past, stuttering was thought to be due to psychological factors such as anxiety. We now know the cause of stuttering is not due to anxiety. Rather, it is regarded as having a neurological cause - differences have been found in areas of the brain involved in talking for those who stutter compared with those who do not stutter. In addition, stuttering has a genetic or hereditary component and tends to run in families. 

Do I stutter because I am an anxious? Am I anxious because I stutter?

Research has shown us that pre-school children who stutter show no difference in shyness or anxiety compared with pre-school children who do not stutter. People who stutter are no different to people who do not stutter in terms of their personalities. However, research has shown that as a group people who stutter present with higher levels of anxiety and are more likely to present with social anxiety disorder compared with people who do not stutter. The age at which anxiety symptoms begin to appear is not yet clear, however some studies have suggested that higher anxiety is shown in stuttering children from the age of 7 years and increases over time.  

Indeed, it is not surprising that stuttering is associated with increased levels of anxiety. The experience of stuttering is often difficult and people who stutter describe having a variety of negative emotional reactions to their talking including feelings of embarrassment and shame. They can also experience negative reactions to their stuttering from others.  We know that children who stutter are more likely to be bullied and to be viewed negatively by their peers and adults describe stigma and discrimination both socially and in their place of work. The anxiety demonstrated by people who stutter is regarded as being the result of living with stuttering and is not the cause of stuttering.  You don’t stutter because you are an anxious person.

How does anxiety or nervousness impact stuttering? 

Although people vary, we know that when someone is feeling anxious or nervous, they tend to stutter more. You might be feeling anxious about stuttering in front of others or concerned about how your listener will react, or what they will think if they hear you stutter. When we feel anxious or nervous, it is usually because we are expecting the worst to happen. You might be saying things to yourself like “I won’t be able to say my name” or “They’ll think there’s something wrong with me” This may lead you to tense your muscles, may distract you from focusing on what you want to say as you try hard either to be fluent or to hide your stuttering.  This can all lead to more stuttering. You may feel like you have suddenly started stammering.  It is important to remember that while you may stutter more when you are feeling anxious or nervous, these feelings are not the cause of stuttering.  

How can Speech and Language Therapy help with Stuttering? 

We know that learning more about your stuttering and what influences it can reduce your anxiety about it.  Speech and Language Therapy can be effective in reducing the impact that stuttering is having on your day to day life.  You can develop your confidence to communicate, learn how to respond differently to your thoughts and feelings about stuttering and to learn strategies to make talking easier and more comfortable. 

Stuttering does not have to hold you back. 

We are Clinical Specialists in Stuttering and are very happy provide you with more information regarding our reasonably priced fees via email.

What is a vocal fold paralysis?

What is a vocal cord paralysis?

A vocal fold palsy or vocal fold paralysis is when one or both of the vocal folds do not open or close properly. In most cases, only one vocal fold is affected. Paralysis of both vocal folds is a rare and serious condition.

The vocal folds are two elastic bands of muscle tissue located in the voice box directly above the windpipe. When you use your voice, air from the lungs causes your vocal folds to vibrate between open and closed positions. If you have a vocal fold paralysis, the paralysed fold may remain open. The voice then becomes weak and breathy.

What causes a vocal fold paralysis?  

The most common cause is a viral infection. It can be as a result of nerve damage due to surgery, injury or certain cancers. Neurological conditions such as Parkinson’s disease of multiple sclerosis can also lead to a vocal fold paralysis.

What are the symptoms of vocal fold paralysis?

Symptoms of a vocal fold paralysis are changes to a person’s voice. A breathy, hoarse or weak voice is common. Some people report difficulties swallowing and a swallowing assessment may be required by a Specialist Speech and Language Therapist in Dysphagia. Sometimes people become more breathless with exercise or find it hard to life heavy items.

Can vocal fold paralysis be cured?

Typically, damage is temporary and will improve over several weeks. However, the majority of people will require Voice Therapy by an experienced Speech and Language Therapist to improve their voice. Treatment is available via the NHS for free. We often treat people when there is no voice therapist available or they are waiting for NHS therapy. Online Speech Therapy for Voice is effective.

Our Private Voice Therapists are Clinical Specialists in Voice. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.

What is Speak out! What is Lee Silverman Voice Treatment (LSVT LOUD)?

What is Speak Out! ® & Lee Silverman Voice Treatment (LSVT LOUD) loud for Parkinson’s Disease?

Speak out ! ® and Lee Silverman Voice Treatment (LSVT Loud) ® are intensive Speech Therapy treatments for Parkinson’s disease focusing on improving voice and volume. They both have a strong evidence that they are effective treatments. Both are seen as the best Speech Therapy for Parkinson’s Disease. Certification is provided to Speech and Language Therapists following a training program. Our Speech and Language Therapists are certified in both treatment Techniques and have experience of providing these treatments online with effective results.

How can Parkinson’s Disease affect speech?

Parkinson’s disease can cause people to talk quietly, have reduced variation in pitch and a hoarse voice. People with Parkinson’s Disease are often not aware that they are talking quietly - we need to work with you to recaliberate your sensory feedback to raise your awareness of your loudness, improve voice projection and reduce effort in conversation.

What is Lee Silverman Voice Treatment (LSVT loud)® for Parkinson’s Disease ?

LSVT loud ® stands for Lee Silverman Voice Technique. It is a technique that improves loudness for people with Parkinson’s disease. Studies have shown it can also be used in a variety of neurological conditions to improve Speech.

Lee Silverman Voice Treatment ® (LSVT Loud) focuses on increasing loudness. Research has also shown improvements in swallowing and articulation. LSVT requires an assessment session, and 12 therapy sessions, at 60 minutes each.

What is Speak Out® for Parkinson’s Disease ?

Speak out! was developed by the Parkinson’s Disease Project. It focuses on producing a stronger, clearer voice. It focuses on the concept of intent and strengthens the muscles used for speaking. Speak out! ® requires 8-10 sessions, at 45 minutes each. It can be easier for people to fit Speak out! ® into their daily life, and it can reduce overall cost of treatment. Speak out! provided a free training workbook for clients.

Once treatment is complete, the Parkinson’s Disease project hold LOUD crowd groups and free Facebook practice sessions. This is important in maintaining the gains in therapy.

We offer both SPEAK OUT!® and LSVT loud ® with certified clinicians

Click on the contact us button to arrange a free consultation or send us an email for more information regarding our reasonable fees for Speech Therapy for Parkinson’s Disease.

What is a cognitive communication disorder?

What is a cognitive communication disorder?

A cognitive communication disorder is a difficulty with communication caused by cognition rather than language or speech difficulties.

What causes a cognitive communication disorder?

Cognitive communication disorders occur due to damage to the brain as a result of a stroke, brain injury or any neurological disorder. It can affect someone’s cognitive processes including attention, memory and reasoning.

How do cognitive difficulties affect communication?

Cognitive difficulties are reflected in a person's communication. They may not be affected by all of the items below but you may recognise elements that you might be able to support with the guidance given.

Attention: A person’s ability to concentrate may be affected by difficulties maintaining attention. This may cause them to miss important information in a conversation.

What can you do to help someone with attention difficulties?

• Reduce distractions such as turning off the radio or television to talk in a quiet environment so they can concentrate.
• One task at a time
• Gain the persons attention before beginning an important conversation
• Give information in shorter chunks .
• Take frequent breaks when tired.

Memory: A person’s ability to remember things that have happened recently (short-term memory) and sometimes longer term. They may repeat information or be unable to recall things that have happened to them earlier in the day.

What can you do to help someone with memory problems?

• It doesn't always help to ask them questions about things that have happened recently – most people find this distressing and it will not help their memory. Give them the information and comfort them.
• Use familiar objects such as photos on your phone or a newspaper to share information together
• Talk about the past if they are able to remember as this is not reliant on short-term memory.
• Ask family and friends to write in a book and this can be used as a conversation starter of who has visited and what you may have talked about together.
• Use memory aids such as a diary and apps on phones for reminders

Reasoning/problem solving skills: A person’s ability to think through and solve a problem may be affected leading them to make poor decisions.

How to help with poor reasoning:

• break down the problem
• brainstorm solutions together
• talk about the positives or negatives of each solution
• pick a solution
• talk about what happened.

It might be that someone is unable to discuss their decisions – and they may be reliant on others to support them in making decisions in their best interest. This often involves an assessment of capacity if it is a big decision about their life. A team of professionals is normally involved in these decisions, with the patient and family.

Other aspects of cognition that are affected:

Insight: A person’s ability to understand their limitations. An example of poor insight might be a person that has a left sided weakness and are at risk of falling but they still think that they can walk by themselves.

Slowed information processing: People might find it difficult to keep up with a conversation and feel overloaded with information.

Impaired social communication skills:
When a person may not recognise ‘normal’ or ‘natural’ ways of communicating with others. This means that they sometimes are seen as rude or passive.

• Turn taking skills: talking over someone, interrupting, talking only about themselves or not starting conversations
• Not understanding body language
• Being sexually explicit or swearing lots.

What can a speech therapist do for cognitive communication disorder?

We assess using cognitive communication assessments and gather information about the person themselves to ensure we are providing patient-centered and motivating therapy to improve the persons communication and support to family members.

Is Online Speech Therapy Effective?

Online Speech Therapy (often called Tele-health in research studies) has been shown to be effective and often better in treating many conditions. Studies have looked at comparing online Speech Therapy vs seeing the clinician in person, often referred to face-to-face therapy.

Research shows us that Online Speech Therapy has shown be effective and has high levels of satisfaction for clients.

If you are interested in whether Online Speech Therapy is effective in your condition please see the relevant research below.

Is Online Speech Therapy effective for Language difficulties (Aphasia)?

The Efficacy of Telepractice on Expressive Language Outcomes for Adults with Aphasia: A Systematic Review Morgan Bailey B.S., Lauren Burningham, B.S., B.A., Erin Fifield, B.A (2018)

This study examined whether online Speech Therapy produces positive expressive language outcomes that are comparable to face-to-face therapy for adults with aphasia. They looked at all studies that have compared online Speech Therapy to face-to-face.

The results indicated that online therapy produces similar outcomes when compared to traditional face-to-face therapy.  Most studies showed positive patient satisfaction and quality of life.

Is Online Speech Therapy effective for Dysarthria (Slurred Speech)?

Telemed J E Health 2009 Nov;15(9):840-50.The Redesign and Re-Evaluation of an Internet-Based Telerehabilitation System for the Assessment of Dysarthria in AdultsAnne J Hill 1, Deborah G Theodoros, Trevor G Russell, Elizabeth C Ward

 This study showed high levels of satisfaction from patients being assessed Online. It also showed good strength of agreement between Online Speech Therapy in comparison to face – to –face assessment.

Is Online Speech Therapy effective for dysphagia (Swallowing difficulties)?

Morrell, K., Hyers, M., Stuchiner, T., Lucas, L., Schwartz, K., Mako, J., Spinelli, K. J. & Yanase, L. (2017). Telehealth Stroke Dysphagia Evaluation Is Safe and Effective. Cerebrovascular Diseases, 44 (3-4), 225-231. 10.1159/000478107.

 For swallowing difficulties (dysphagia) 100 patients were assessed comparing face to face with Tele-health (online speech therapy assessment) showing excellent agreement between therapists. This study indicated that online speech therapy was a safe and effective way to deliver dysphagia assessments online.

Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation. Elizabeth C. Ward,1,2 Clare L. Burns,3 Deborah G.Theodoros,l and Trevor G. Russell1

100 patients were assessed online and face to face. Results for swallowing difficulties were comparable to face to face assessment. There were high levels of patient satisfaction and patients felt comfortable with online assessment.

 Is Online Speech Therapy effective for Voice?

Voice Therapy Using Telecommunications Technology Pauline A. Mashima et al. American Journal of Speech Language Pathology. Vol 12. 2003.

This study showed that there was no difference in face-to-face outcomes vs online therapy. All patients had positive changes following rehabilitation for their voice through speech therapy.

 The effectiveness of Lee Silverman Voice Treatment therapy issued interactively through an iPad device: A non-inferiority study. Journal of Tele-medicine and Tele-care. 2017 Murray Griffin et al.

Lee Silverman treatment is the recommended Speech Therapy treatment for Parkinson’s Disease. It is intensive requiring four sessions a week for four weeks. For those people that struggle to travel, online therapy is ideal. This study even showed that online showed superior improvements than face-to-face therapy.

 Is Online Therapy effective for Stammering?

Research is in its infancy for stammering and online therapy. An NHS trust completed an improvement project in 2018 that looked at treating patients using online Therapy. The Therapy showed a reduction in the negative impact of stammering and many clients preferred therapy in their home environment rather than in a clinical setting.  

What can I do to look after my Voice?

• Stop smoking. If you can’t give up, cut down. Smoking irritates and damages the vocal folds. Talk to your GP about advice to support stopping smoking.

• Avoid eating spicy foods. Spicy foods can cause stomach acid to move into the throat or oesophagus, causing heartburn or reflux. If you do experience reflux, talk to your GP about possible medications.

• Avoid too much coffee, fizzy drinks and alcohol. These can dry out the vocal cords. Try drinking decaffeinated tea or coffee or follow an alcoholic drink with a soft drink.

• Avoid shouting and whispering

• If your voice feels tired or strained then rest it. This is your bodys way of telling you to rest your voice

• Try not to clear your throat unnecessarily. It can create excessive mucous and lead to a further need to clear your throat. Try drinking water instead or swallowing.

• Avoid dry and dusty atmospheres as they may dry out the vocal cords. Wear a mask in a dusty environment.

• Try to drink 2 litres (3 ½ pints) of liquid a day (not including coffee, alcohol or fizzy drinks). This will prevent dehydration of the vocal cords.

• Try steaming to keep the vocal folds hydrated

Our Private Voice Therapists are Clinical Specialists in Voice. Book a free 15 minute consultation or email us at thespeechnetwork@hotmail.com to enquire about our reasonable fees for Voice Therapy.

What is Aphasia?

 How is aphasia caused?

 Aphasia is caused by damage to the language areas of the brain. In most people, this is typically the left hand side of the brain. It is most commonly caused by a stroke or a brain injury. It can also be caused by progressive disorders such as brain tumors.

How does aphasia affects communication?

 It can affect a persons understanding, speaking, reading and writing. Symptoms can vary in severity from people not being able to express themselves by any means, to milder symptoms of a delay in accessing words. However, even mild symptoms can have an impact on peoples confidence requiring Speech Therapy.

Does aphasia go away?

 It depends on the cause and severity of the aphasia. If it is caused by a brain injury and stroke, it is likely to improve. If it is caused by a progressive disorder this is means that it will unfortunately not improve.

Can aphasia be cured?

Speech therapy aims to restore a persons language through exercises but also support them

Can Aphasia be treated?

The treatment for Aphasia is with Speech and Language Therapy. Evidence shows that Speech Therapy is effective for people with Aphasia following a stroke, compared to no therapy.

How can you help someone with Aphasia?

After an assessment, a Speech Therapist will be able to give you specific advice about the best ways in which to communicate.

Below is some general guidance:  

• Give the person plenty of time to respond. If a person with Aphasia feels rushed or pressured to speak they may become anxious, which can affect their ability to communicate.

• Use short, uncomplicated sentences.

• Do not change the topic of conversation too quickly.

• Avoid finishing a person's sentences or correcting their errors.

• Reduce distractions.

• If you don't understand something a person with Aphasia is trying to communicate, don't pretend you understand.

• Use visual references, such as pointing, gesturing and objects, to support their understanding.

• If they're having difficulty finding the right word, prompt them – ask them to describe the word, think of a similar word, try to visualise it, think of the sound the word starts with, try to write the word, use gestures, or point to an object.

Our Speech and Language Therapists are Specialists in Aphasia. Feel free to book a free consultation or email us for further information.