ErinN.Donahue,B.M.,M.A.,CCC-SLP

TheBlaineBlockInstituteforVoiceAnalysisandRehabilitation(BBIVAR)Dayton,OH

(937)496-2622www.BBIVAR.com

TheProfessionalVoiceCenterofGreaterCincinnati(ProVoiceCenter)Cincinnati,OH(513)632-5805

www.ProVoiceCenter.com

TopicsofDiscussion

!  VoiceBasics:Review!  AnatomyandPhysiology

!  Approachestovoicemodificationforfeminization/masculinization

!  Voicetherapyprocess/protocol

ErinDonahue,CCC-SLP–OneVoiceFestival2018

VOICEBASICS:SubsystemsofVocalProduction

ResonancePhonationRespiration

Respiration

PowerSourceforPhonation

Phonation:LARYNX

Phonation:VOCALFOLDS

! AKAVocalCords!  Smooth&StraightEdges! PearlyWhiteColor!  Flexible! Moisturized

DifferencesinLaryngealAnatomy

! LengthofVocalFolds!  Average(AMAB-Male)VFsbetween1.75-2.5cminlength!  Average(AFAB-Female)VFsbetween1.25-1.75cminlength

VocalFoldVisualization:LaryngealVideostroboscopy

Resonance:VOCALTRACT

VocalTract!  Size/ShapeDifferences

TypicalVoiceCharacteristicsinMasculinevs.FeminineVoices

!  SpeakingPitch!  Male:85-170Hz(E/F2-E/F3)!  Female:170-250Hz(E/F3–B3/C4)!  “GenderNeutral/Ambiguous”:145-185Hz(D#3-G3)

!  Resonance!  Inflection/Prosody!  Articulation!  Language! Non-VerbalCommunication

VocalHygieneOverviewImportantforEVERYVocalPerformer!!

!  Hydration!  GuidelinesforInternalHydration

!  VocalPacing!  VocalNaps!  AvoidOveruse

!  AvoidanceofVocalAbuses(Phonotrauma)!  VocalExtremes(Intensity)!  ExcessiveClearing/Coughing

!  AvoidanceofIrritants!  Environmental(Smoke),Internal(Reflux)

! Warm-up/Cool-down!  TrainlikeanAthlete

VoiceModificationOptions! None! DirectVoiceTherapy

!  FeminizationorMasculinization!  Independent

!  TrialandError,MimickingVoiceModels,etc.!  Youtube,Apps,Peers,etc.

! Surgical!  Pendingtrialofdirectvoicetherapy! Multipleoptionswithvaryingdegreesofsuccess/satisfaction

! MedicalManagement! HRTformasculinization

HormoneReplacementTherapy(HRT):Masculinization

!  Loweredpitch!  often(notalways)approximatelyoneoctave!  increasedvocalfoldmass

! Resonancechange! maxillaryandmandibulargrowthandloweredlarynx

Goals,targets,andtherapyapproaches/exercisesinvoicemasculinzationoftendifferwhenpatientisonHRTduetothese

changes

RedFlags:Symptoms!  VocalSymptoms

!  Vocalfatigue!  Prolongedhoarseness!  Effortfulphonation!  Changeinvocalqualityorrange!  Decreasedvocalflexibility/agility!  Breaks,fuzziness,breathiness,holes,lossofrange,lossofdynamiccontrol

!  ChangeinSensation!  Necktightness,discomfort,aching(muscular)!  GlobusSensation(lumpinthethroatfeeling)!  ThroatPain(atrestortask-specific)

!  Other!  Burningorbittertaste/rawthroat!  Throatdryness!  Chronicthroatclearingornon-productivecoughing

Whattodoifyouthinkyouhaveavoiceproblem

! Reviewvocalhealthandhygiene! Pinpointonsetofproblemandbeabletodescribe! Havealistofcurrentandupcomingvocaldemands! Don’twait,seekhelp!Donotwaituntilcrisispoint!

!  VoiceCareTeam!  Voice/MusicTeachers!  Ear,Nose,ThroatDoctor(ENT)!  VoicePathologist/SingingVoiceSpecialist

VoiceTherapyforVoiceModificationResearchandHistory

! Researchbeganinthe1970’s! Ongoingresearchpublishedinmultipledisciplinesandjournals

! WorldProfessionalAssociationforTransgenderHealth!  www.wpath.org

! VoiceandCommunicationTherapyfortheTransgender/TranssexualClient:AComprehensiveClinicalGuide–RichardAdler,SandyHirsch,andMichelleMordaunt(neweditionintheworks)!  AnitaKozan’sChapter–TransSingingVoice

VoiceTherapyAnon-medical,non-surgicalapproachfor

individualswhowishtorehabilitateormodifytheirvoiceinasafe,efficient,andhealthywayinordertofacilitateadesiredvocaloutcomeand

providevocallongevity

Thegoaloftransgendervoicetherapyistoaidtheindividualinmodifyingtheirvoiceinasafeandhealthymannerthatwillfacilitatethatindividual’sdesiredvocal

outcomeandprovidevocallongevity.

BenefitsofVoiceModificationTherapy

!  IndividualizedProgram!  Structuredexercises!  Targetedtowardsindividualsabilitiesandgoals

! KnowledgeableInstructor!  Ensurehealthyvocaltechniques!  Externalimmediatefeedbackandreinforcement!  Specificandconsistentlanguageandinstruction

SoundFamiliar?

BBIVAR/ProVoiceCenterProtocol!  InitialEvaluation

! WrittenandVerbalHistory(medical,personal,vocal)!  Self-AssessmentMeasures!  LaryngealVideostroboscopicexamination

!  StartVoiceTherapy!  AcousticandAerodynamicMeasures!  BeginVoiceTherapyExercises

!  SubsequentVoiceTherapySessions

AspectsofVoiceAddressedinTherapy

! Pitch! Resonance!  Intonation/Prosody! Articulation!  Language! Non-VerbalCommunication! Carryoverintofunctional,everydayvoiceuse

! AnySpecificVoice-RelatedSymptoms/Complaints

VoiceTherapyDeliveryModels/Options

!  INDIVIDUALTHERAPY! Oneonone!  Individualized! Nosettimeframeorgoals

! GROUPTHERAPY!  Supportofothers!  Feedbackfrompeers!  Functionalpractice

PotentialGoalsinVoiceMasculinizationTherapy

! VocalHygiene! PotentiallyLessFocusonPitch

!  Resonance!  Intonation/Prosody! Non-VerbalCommunication!  Language!  Carryoverintofunctional,everydayvoiceuse

! AddressingSymptoms!  ThroatPain/Discomfort!  VocalFatigue! Hoarseness

Singers! Benefitsforvoicemodificationtherapy

!  Trainedears–pitchmatching,pitchidentification/discrimination

!  Controlovervoice–increasedabilitytomakeadjustmentsoncommand

!  Vocalflexibility,agility,strength,stamina!  Jargon/Vocabulary!  “Schema”forvoiceproduction!  Self-awareness

VoiceModificationTherapy!  VocalHygieneRecommendations

!  Hydration!  Eliminationofanyphonotraumaticbehaviors!  Otherrelevantrecommendationsrelatedtovoice/throat

!  Lifestylefactors,exposuretoirritants,smoking,clearing/coughing,managementofillnesses,etc.

!  EliminationofMuscleTension!  Deactivationstretching!  ProgressiveRelaxation

!  Respiration!  Efficientbreathing

!  Diaphragmaticbreathingexercises

VoiceModificationTherapy!  Pitch

!  Determinegoal/targetpitch!  Shorttermvs.Longtermpitchgoals!  Pitchraising/Lowering

!  ModifiedVocalFunctionExercises!  Semi-OccludedVocalTractTechniques

!  PitchRange!  Resonance

!  Efficientvoicethroughtargetresonance!  ResonantVoiceTherapyExercises

!  Articulation!  Prosody/Intonation!  Language!  Non-VerbalCommunication

VoiceModificationTherapy

! Articulation! Prosody/Intonation!  Language! Non-VerbalCommunication

SingingVoice! VocalExercises

! Warm-upRegimen!  Stretchingandcontracting

!  ConditioningExercises/Vocalise!  PitchRange/Flexibility!  Strength!  Agility!  Stamina

!  Cool-downRegimen

Thankyou!edonahue@soents.com