Voice Problems

  • Voice Disorders
  • Muscle Tension Dysphonia
  • Vocal Fatigue (Voice is Hoarse / Weak / Tired)
  • Vocal Nodules and Polyps
  • LSVT LOUD Therapy & Parkinson’s Disease
  • Vocal Cord Dysfunction
  • Chronic Cough


This instrument allows us to bring invaluable diagnostic measures regarding the function of your voice. It requires no anesthesia and is a fairly quick procedure. The scope that we use has a small wire with a camera on the end which is paired with a strobe light source. We pass this wire through your nose to the back of the throat where we can visualize the areas within and surrounding the voice box. This exam allows us to better identify any issues with voicing by capturing the movement of the vocal fold vibrations. We can then assess for structural abnormalities, recruitment or lack of recruitment with important muscles for voicing, as well as the ability of the folds to come together when speaking.

Voice Disorders

Is your voice giving out on you? Are you finding it harder to speak as the day goes on? Or maybe you’ve already been diagnosed with vocal nodules or polyps and need to rehabilitate your voice. Whatever the difficulty, we’ve got you covered!

There are many disorders that can affect the way the vocal folds (or vocal cords) come together. They can impact the way your voice sounds and in some cases impact your ability to swallow food or drinks safely. We always recommend you start with an assessment by an ENT (Ear, Nose and Throat doctor). This way we can be sure that there are not any underlying deficits that may need to be addressed first before therapy can begin. It also ensures we are targeting the right therapy treatments for your particular issue.

We work closely with Lake ENT and highly recommend them as a starting point for you: Click here to learn more about Lake ENT

In more complex circumstances, you would want to choose an ENT with specialized training for your current difficulties. A Laryngologist is an ENT that has completed further studying and board exams to subspecialize in the areas of voice and swallowing. A laryngologist can be very difficult to find, and there are only a handful in the state of Florida. The closest one to Lake County that we recommend is Dr Neil Chheda at UF Health Gainseville. Click here to learn more:

Click Here To Learn More About Dr Neil Chheda at UF Health Gainesville

Vocal Fatigue: Is Your Voice Hoarse, Weak or Tired?

If you have experienced a hoarse or tired voice, then you know vocal fatigue. When the muscles we use for voicing are not used correctly, it can result in strained vocal functions or even pain.

The causes of vocal fatigue can be as simple as overexertion — professional singers, orators and classroom teachers experience vocal fatigue symptoms. They can also underlie clinical conditions like vocal cord nodules or muscle tension dysphonia.

The symptoms of vocal fatigue vary. They include: 

  • Voice giving out 
  • Raspy, breathy voice
  • Reduced pitch
  • Breaks in the voice when speaking
  • Throat discomfort
  • Throat clearing
  • Loss of volume
  • Unsteady voice

​​No matter the cause or onset, vocal fatigue is treatable and often curable.

How Long Does Vocal Fatigue Last?

It is critically important to identify and diagnose the causes of vocal fatigue, which is why we recommend starting with an ENT for your instrumental assessment. Without this important diagnostic information , it’s difficult to forecast your recovery window.

With the help of medical diagnostics and a reliable treatment regiment, Cobalt Therapy can help chart your timeline to vocal fatigue recovery.

What is Muscle Tension Dysphonia?

Muscle tension dysphonia (MTD) develops when too much stress is placed on the small muscles we use for voicing and even the larger muscles surrounding them. The causes of MTD can be unclear. It can be triggered by heightened vocal demand (occupational), allergies (environmental), or by an underlying pathology like polyps, nodules or vocal fold paresis.

Clinicians categorize this condition as primary or secondary MTD. Primary MTD refers to cases where there is no observable anatomical abnormality other than muscle tension. ​​In secondary MTD, a physical abnormality — such as an injury — is present, and other muscles work overtime to compensate for it.

Emotional stress and anxiety can also trigger MTD. Under such conditions, the laryngeal muscles become tense. If prolonged, this tension will alter the coordination of the vocal control system.

Changes in the quality of the voice may be an indication of MTD. In severe cases, patients have reported pain and discomfort while speaking. Some people with MTD develop “aphonia,” or the inability to produce a voice at all.

Can You Recover from Muscle Tension Dysphonia?

Treatment for MTD comes in the form of voice therapy, and is based on whether the diagnosis is primary or secondary. The priority of any MTD treatment plan is to identify and curb the factors causing it. This includes recovering from an illness, removing oneself from sources of stress, or changing one’s vocal demand.

The next step is to establish healthy vocal patterns, and move away from negative compensatory behaviors. A trained SLP is able to identify such behaviors, and formulate voice training exercises to return patients to normal voice functions.

What Does it Feel Like to Have Vocal Nodules or Polyps?

People often describe their voice as raspy, hoarse or scratchy. They may also experience breathiness, loss of pitch control, and even excessive throat clearing, coughing and general fatigue.

What Causes Nodules on Your Vocal Cords?

Stress, strain and trauma are among the usual culprits in the development of vocal cord nodules. This can stem from vocal misuse and abuse, like shouting at a sports event or even talking over the background of a noisy restaurant for too long.

The swelling brought on by these stresses can be exacerbated by conditions like allergies, sinusitis or even gastroesophageal reflux disease (GERD). Dryness from dehydration or caffeine & alcohol intake can also worsen the pre-existing inflammation of vocal cord nodules.

Can a Vocal Cord Nodule Go Away on its Own?

It is possible for vocal cord nodules to diminish and disappear naturally. But this assumes that their cause has been addressed. Total voice rest is the surest way to a natural recovery. Obviously, removing physical irritants like cigarettes, alcohol or polluted air will improve one’s prognosis too.

Common Treatments for Vocal Cord Nodules

The treatment of vocal cord nodules depends on their causes, as well as their severity, size and pre-existing conditions. For cases too advanced for natural measures, surgical removal might be necessary.

As a general rule of thumb, you should see a physician if your voice has been hoarse for more than 2 weeks. We recommend seeing an ear, nose and throat doctor (otolaryngologist) in such cases.

They should be able to determine if this is a voice problem, and identify the presence of vocal nodes. A physician can also prescribe a treatment course for voice-aggravating conditions such as acid reflux of GERD, allergies or thyroid problems.

A speech & language pathology service, like Cobalt Therapy, should then be your next stop. We can test how your voice sounds to help determine severity and an appropriate course for treatment.

We assess your personal needs and life conditions to determine how you can best care for your voice. This can involve teaching you strategies and techniques for altering the way you use your voice in work and life.

We help pinpoint the incremental daily abuses that you may not know are impacting your voice production machinery. Our goal is to help you realize and enjoy your incredible, personal, “well-oiled engine” of a voice.

LSVT LOUD & Parkinson’s Disease

People with Parkinson’s often end up having difficulty with being heard when they speak. A well known technique for treating this is the LSVT LOUD program. It is considered the gold standard among many Speech Pathologists for improving voice in people with Parkinson’s Disease. Our therapists are all certified with the LSVT LOUD program and have seen great results with it! Further research has been showing great outcomes with this program for a variety of other voice disorders.

Click Here To Learn More About LSVT.

What Does LSVT Stand For?

LSVT stands for Lee Silverman Voice Treatment. Dr. Lorraine Ramig officially founded this treatment program in 1985, while treating Mrs. Lee Silverman, a woman who suffered from Parkinson’s Disease.

What Does LSVT LOUD Do?

The LSVT LOUD program improves volume, pitch, articulation, and builds your confidence while improving your audibility, in turn enabling you to communicate in a way that is easy for others to hear and understand. This “gold standard” technique has also been known to improve facial expressions, aid in swallowing, and enhance the neural networks in the brain that process speech.

The LSVT LOUD program was initially designed to help those with Parkinson’s Disease. However, it has also proven to be very beneficial in treating others that are experiencing difficulties with voice, speech, and communication. The medical community has seen many success stories using the LSVT LOUD program with those who have neurological diseases and genetic disorders, such as multiple sclerosis, Huntington’s Disease, cerebral palsy, and Down syndrome.

What is LSVT LOUD Training?

LSVT LOUD training consists of a series of repetitive exercises that will successfully strengthen your larynx, or voice box, while at the same time enhancing your projection. This will result in a lasting and positive effect on your overall communication skills. We have also noticed that the LSVT LOUD training program does wonders to increase confidence for your speaking style in interpersonal relationships.

When dealing with Parkinson’s Disease you will want a neurologist that has further training with complex movement disorders. We highly recommend Dr Anette, Nieves in Ocala. Click here to learn more about Dr Anette Nieves

Vocal Cord Dysfunction

Vocal cord dysfunction is a disruption in the way your vocal folds open. This condition can affect your speech, swallowing and respiration. Breathing can become very difficult and this can be further induced when trying to exercise. This can often be mistaken for asthma because the symptoms are similar.

What are the symptoms of vocal cord dysfunction?

  • Difficulty breathing
  • Feeling short of breath or feeling that it’s hard to get air into or out of your lungs
  • A feeling of choking or suffocation
  • A high-pitched wheezing sound when you inhale, called stridor
  • Frequent cough or clearing your throat
  • A feeling of tightness in the throat or chest
  • Voice changes
  • Hoarseness

Treatment for Vocal Cord Dysfunction

Typically breathing techniques and ways to relax the muscles for improved voicing are developed by your Speech Language Pathologist to help this condition improve. It may take collaboration with a variety of doctors depending on other contributing factors for full resolution of difficulties.

About Chronic Cough

Coughing helps you clear your throat and lungs and can even prevent infection. But sometimes a cough can become chronic. Chronic cough is a cough that lasts more than 4 to 8 weeks.

Signs and Symptoms of Chronic Cough

Chronic cough can be annoying, and it can interrupt your sleep or give you a headache. Here are some symptoms of chronic cough:

  • Frequent need to cough
  • Rough-sounding voice 
  • Frequent need to clear throat
  • Throat feels tight

Causes of Chronic Cough

The most common causes of chronic cough are:

  • Asthma or other breathing problems
  • Allergies or sinus problems that cause “dripping” down the back of your throat
  • Acid reflux (stomach acid that rises into the throat)

Sometimes, chronic cough can be caused by other things like a cold, bronchitis, or certain medications used to treat high blood pressure. For some people, chronic cough is caused by an especially strong instinct to cough due to having a sensitive throat.

Seeing a Professional: Testing for Chronic Cough

You will probably see a team of professionals to find out what is causing your chronic cough. The SLP is an important member of the team. Other members may include the following:

  • Allergist
  • Pulmonologist
  • Otolaryngologist (ear, nose, and throat doctor)
  • Gastroenterologist

The team will go over your medical history and ask how long you have had the cough. They will ask about the medicines you take and if you smoke. They may recommend a chest x-ray or other tests.

The SLP or doctor can look at your vocal folds through a tube, called an endoscope, that goes in through your mouth or nose. This will let them see if your vocal folds and the areas around them are red or swollen. The SLP may also test your voice to see if there are any changes in vocal quality that the cough might be causing.

Treatments for Chronic Cough

The goal of treatment for chronic cough is to give you the tools to manage your cough. You also will become aware of what triggers your cough so that you can avoid those triggers.

You may need medical treatment for chronic cough if you have a medical condition — like asthma, allergies, or reflux — that triggers the cough. If all of these underlying factors are ruled out, your doctor may need to prescribe a low dose neuromodulator while the SLP works to remove negative behaviors that contribute to this cough. Ultimately, the use of a neuromodulator would be short term. Once the brain has “unlearned” the coughing trigger while having breathing strategies in place and removing possible triggers – the neuromodulator can be discontinued.

In some cases, a direct injection performed by a Laryngologist, to block the dysfunctional nerve is required. We work with your doctor to find the most conservative path that will work for you and build from there.

SLPs work closely with your doctors. Treatment by an SLP focuses on:

  • Helping you understand chronic cough and what might trigger your cough
  • Teaching you ways to help reduce coughing, and
  • Teaching you ways to keep your vocal folds healthy including optimal management of reflux