Q: My client had a tonsillectomy and adenoidectomy but she still sounds stuffy and nasal. Mom says she has always sounded this way. Suggestions?

Voice is a very difficult topic for those of us who do not specialize in it.

Many clients do not change their voice and resonance patterns after surgery because the “old voice” is just what they are used to.  It’s the way they always have sounded.  It’s them.

Therapy intends to change that vocal quality.  Unfortunately most SLPs are not very well trained in voice and resonance.  We read textbooks filled with info, but training to do the work has been skimpy for most of us.

I learned the most about voice therapy from watching one of my own daughters go through years of singing, voice, and opera lessons at school and privately.

The essence of treatment is to learn how to play with voice in ways that alter its tone and resonance.  Have your client prolong vowels and make the voice louder and softer, longer and shorter, higher and lower, faster and slower, more nasal and less nasal, bigger and smaller, tinnier and rounder, dramatic and flat, etc.  You are teaching her to listen to and analyze her own vocal qualities.  Then focus more on the oral and nasal resonance aspects.

A client like this also needs to learn to open up her oropharynx so that her sound becomes more oral and more round.  The elocutionists of yore called it orotund.  (This is the kind of work that Alexander Graham Bell did with his hearing-impaired clients, according to the lectures of his I have read.)

The orotund voice is made by opening up the mouth more (lowering the jaw) and by expanding the inner oral and inner oral-pharyngeal space.  Yawning helps clients understand this. Learning to pull the back of the tongue down also helps.

Using a mirror to see all of this is essential for the client.

Bell recommended that therapists figure out how to do this with their own voice first.

I believe that every SLP should take a few voice lessons from a singing teacher to learn these basic procedures.  I feel student SLPs should have to take at least one class on voice from a teacher in the music/voice/theater department.  Many of the old methods that SLPs used to use back in the day have been retained in classes for music and singing majors but most have not carried over into our profession.

I have not checked, but I would bet that there are videos online to be found about how to train a singing voice that would be very useful for SLPs to study. [My singing daughter recommends a search for classical music training since classical singing requires clear vowels and more resonance than other styles of singing, and demands the most breath support.]