“A teacher without a voice? Unimaginable!”

I have been in post as Clinical Lead for voice since September 2016 and I am proud to be part of the Voice Service. We are two therapists and an administrator, who work closely with Ear, Nose and Throat to help patients with a variety of voice disorders.

One of the questions that I am frequently asked about my job is: “How does it differ from other SLT posts?” Within the Voice Clinic we specialise in the voice, voice disorders and their remediation. We generally don’t look at swallowing difficulties, dysfluency (stammering), acquired communication disorders (e.g. aphasia post-stroke) or motor-speech difficulties (dysarthrias) secondary to either stroke or neurological disorders; all of which are areas generally covered by SLT.

What it’s like to lose the power of speech

For many people, unless they have experienced a voice difficulty themselves or know someone who has, they may not have thought much about their voice, how it works or the potential impact of it not being there. Voice problems can impact people socially, emotionally and financially.

We would encourage anyone who has noticed a change to the way that their voice sounds and feels, which lasts for over three to four weeks to seek advice from their GP. The GP will usually arrange for an assessment with an ENT consultant, who will take a case history and carefully examine the nose, throat, larynx and vocal cords with a nasendoscope. With clear information about the larynx they might then refer to the individual to us in the Voice Clinic.

Often, the way someone has learnt to use their voice over time is the main contributing factor to a voice problem and many people will have been living with and trying to manage their voice problems for many months before finally seeking help.

A Teacher without a voice? Unimaginable!

I recently treated a primary school teacher who had been experiencing difficulties with her voice on and off for well over a year. She found that her sounded rough and breathy; lacked power and tired quickly. She found that by the end of the working day, her voice was very effortful to produce and she struggled to make herself heard in her busy, boisterous classroom. She was understandably very anxious about her voice as she was worried about her future as a teacher.

ENT found that she had small vocal cord nodules (small bilateral lesions on the vocal cords).  Nodules are usually present because of vocal overuse (because of having to speak a lot over background noise) but are treatable in the early stages by carefully changing vocal habits.

She was encouraged to drink plenty of water, avoid throat clearing and use a portable amplifier in class to support her voice in noisy situations. Exercises to reduce the strain and effort that she had developed over time when speaking (sometimes described as muscle tension) were practised and gradually the nodules resolved.

What else do we do?

We also work with transgender clients to achieve a voice that best reflects their identified gender. These are the only clients that do not need to come to us via ENT, as generally we are working with healthy voices to slightly alter the way that they sound. The process usually involves asking our clients what their goals for their voices are and how would they like it to sound.

We teach them them about how the voice works, how best to look after their voices and then working through structured exercises involving pitch change, intonation patterns and sometimes language. This is a collaborative process that may change overtime as our clients change.

The core of what we do within the Voice Service is working to help individuals improve, maintain and maximise their voices.

Denise Clifford

Specialist Speech and Language Therapist

Clinical Lead in Voice

The Voice Clinic


Denise is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from Speech and Language Therapy, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.

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