Voice Therapy for Sulcus Vocalis in Melbourne and Online

Sulcus Vocalis is a relatively rare condition where the vocal fold has a trench-like hollow on the upper middle edge. This creates a ledge-like indent on one or both vocal folds, which impacts how they vibrate when you are speaking.

The indent, called a sulcus, can vary in length and depth. In many cases, it causes the voice to vibrate irregularly, creating a hoarse quality.

What causes sulcus vocalis? 🤔

Scientists haven’t yet identified the cause of sulcus vocalis, but some studies suggest it can result from voice misuse, leading to chronic vocal fold inflammation, which might then cause tissue change. Some other theories suggest it might be genetic or developmental.

How does sulcus vocalis affect the voice?

When someone suffers from sulcus vocalis, it is not uncommon for their voice to sound breathy or hoarse. When we use our voice, the vocal folds need to come together to make a seal, which our breath then bursts open to start them vibrating. With sulcus vocalis, the vocal folds have difficulty moving symmetrically to create an even seal during the vibration cycles. In some cases, sulcus vocalis might also result in a higher speaking pitch due to the tissue abnormalities.

Does Voice Therapy help sulcus vocalis?

It’s still not entirely known whether voice therapy for sulcus vocalis is always effective. Some case studies have shown positive improvement, but as more extensive research is needed, this conclusion can’t yet be generalised to all cases.

If you were to trial therapy, a baseline assessment from an Ear Nose & Throat Specialist is essential, as well as a thorough acoustic voice assessment by a speech pathologist. Be sure to request information on acoustic changes (objective measures of your voice vibration) across a short course of treatment to monitor whether the therapy strategies have been effective for your voice. Also, it’s important to be diligent in practising voice therapy exercises outside of sessions. Voice therapy is not a quick fix, and consistent home practice is required to see if it is effective for you.

Classify the type of Sulcus before treatment

If you are a speech pathologist considering whether to treat a patient with sulcus vocalis, one study (Kumar et al. 2016) recommends that the type of sulcus be classified prior to voice therapy intervention.

Sulcus Vocalis can be categorised into 3 core groups (Ford et al.):

1. The sulcus appears on the surface of the voice (superficial type), and causes no vocal anomalies.
2. The sulcus makes a deep furrow on the vocal fold, resulting in some dysphonia and voice quality anomalies.
3. The sulcus appears in a pouch like form, causing severe voice quality impacts and dysphonia.

What voice therapy methods are the best to trial for sulcus vocalis?

As we mentioned earlier, sulcus vocalis causes a gap between the vocal folds when they need to come together to produce voice (known as midline approximation), and also reduces the resulting wave vibration of the tissue (mucosal wave). Because of this, the recommended approaches for sulcus vocalis include optimising vocal hygiene and minimising compensatory strategies that misuse the voice.

It’s also helpful to investigate any secondary conditions that impact the voice such as reflux. It’s recommended that voice therapy for sulcus vocalis includes Vocal Function Exercises and Resonant Voice therapy, with the aim of minimising the effort required to produce voice and optimise airstream coordination, in spite of physical factors causing misalignment (Kumar, 2016).

Book a diagnostic voice assessment now

Voice Science™ provides vocal nodules therapy in Melbourne to local clients. You can book for face to face voice therapy sessions in our Collins street clinic in Melbourne. If you don’t live in Melbourne and want to do voice treatment with us, don’t worry! We also give online voice therapy sessions for clients located elsewhere in Australia or overseas.

How else is sulcus vocalis managed?

In some cases, vocal surgery can be helpful for sulcus vocalis, and is worth discussing with an Ear, Nose & Throat surgeon who specialises in voice.

The most commonly used surgical procedure is called vocal fold medialisation, which aims to improve the positioning of the vocal folds to eliminate the gaps between them that can come from having a sulcus. In some cases, an injection into the vocal folds (intrafold injection) is also used.

In one single case study, a patient had 15 voice therapy sessions before any surgery and improvements were observed across various measures (acoustic, aerodynamic, perceptual and the patient’s own report), and the patient also reported improvement. (Rajasudhakar, 2016).

Where to begin if you need specialised voice therapy for sulcus vocalis?

At the bottom of this page, you’ll find our Voice Therapy Query Form. Filling that out is the best way to get in touch and set the wheels in motion to improve your vocal health and function.

Considering we can’t see our own vocal folds, it’s impossible to know if we have sulcus vocalis without assessment by either an Ear Nose & Throat Specialist (ENT) or speech pathologist using specialised equipment. A helpful way to think about it is that an ENT usually gives the official diagnosis and a speech pathologist guides you through therapy. This partnership also means that whichever of the two you start, you’ll be referred to the other if necessary.

So let’s imagine you’ve noticed that your voice has a hoarse or breathy quality and have no other information yet. A voice assessment with a speech pathologist would be a good starting point. Take a look at our Voice Tone Test to get started. After submitting recordings for our clinicians to assess, you’ll then have a one-on-one session to find out whether we recommend therapy and/or a referral to an ENT to investigate further.

On the other hand, let’s say you’ve already seen an ENT, you have a diagnosis of sulcus vocalis, and you reach out to us for voice therapy. In this case, it’s important that you provide us with any assessment information from your ENT so we’re working as a team and know what their recommendations are. As well as that, our Voice Tone Test is still an important starting point so that our clinicians are introduced to your current vocal function and voice quality (which is often hard to fully gauge from written descriptions and diagnosis alone!).

Whichever way you come through, we’re here to guide you through the process. You can find out more about Voice Science’s voice therapy options here.

As an absolute first step, we recommend that you submit our Voice Therapy Query Form below and we’ll get back to you to guide you through the rest of the process!

References

• Ford CN, Inagi K, Khidr A, Bless DM, Gilchrist KW; . Sulcus vocalis: a rational approach to diagnosis and management. Ann Otol Rhinol Laryngol. 1996;105:189-200
• Kumar, Rawish & Sharma, Preeti & Vir, Dharam. (2016). Voice Therapy outcomes in Type-I Sulcus Vocalis: Case Studies. International Journal of Clinical & Experimental Otolaryngology. 42-44. 10.19070/2572-732X-160009.
• Rajasudhakar R. (2016). Effect of voice therapy in sulcus vocalis: A single case study. The South African journal of communication disorders = Die Suid-Afrikaanse tydskrif vir Kommunikasieafwykings, 63(1), e1–e5. doi:10.4102/sajcd.v63i1.146