Voice and resonance disorders can be a result of psychological, physical and/or physiological issues. Polyps, Vocal Modules, granulomas, thyroidectomy, vocal overuse/abuse, Parkinson's Disease, Spasmodic Dysphonia, vocal performance, Paradoxical Vocal Fold Motion (PVFM), and head/neck cancers are among the issues that Speech Language Pathologists (SLPs) address. 

But what about Voice and Tongue Tie?

Research shows that Functional Oral Restrictions (aka tongue-tie or lip-tie) do impact an individual's eating, swallowing, breathing, facial development and speech as well as sleep disordered breathing such as apneas or snoring among much more. But they can also impact voice and resonance. A restricted tongue doesn’t only impact articulation – your ability to make the sounds correctly. Speech includes so much more than just articulation. Research has shown significant improvements in fluency (stuttering), speech delay, and many patients have reported increased ease of speech and endurance after a functional lingual release (medically known as Frenectomy). In the professional singing arena (whether it’s opera, theater, or even touring music groups), tongue/lip tie is not often considered as a contributing factor in a singer’s vocal endurance, range and resonant quality. The tongue is not a free-floating organ. The base of the tongue is connected all the way down into the larynx at the level of the hyoid bone. It makes logical sense that a "restricted" tongue can affect the tension of the entire laryngeal area, thus impacting ones vocal quality. It is not difficult to imagine that a singer's vocal range or endurance might be impacted or lessened when it is working against physical resistance. 

Numerous extrinsic lingual muscles are responsible for lingual movement. There are four pairs of extrinsic lingual muscles, which include the genioglossus, hyoglossus, styloglossus and palatoglossus. These extrinsic lingual muscles produce the lingual movements that the intrinsic muscles can’t produce such as protrusion, retraction/retrusion, depression and elevation. These extrinsic lingual muscles are connected throughout the neck, larynx and thoracic area. 

Clearly, any restriction in the body’s main articulator (the tongue) which is connected to the main organ responsible for speech (the larynx) – could greatly impact a person’s ability to optimally use their voice to produce the best quality sound. The upper lip could also be restricted, which impacts bilabial articulation sounds (B, P, M, and W) as well as buccal frena restrictions in the cheeks to a lesser degree. Many professional singers who are masters of their craft (along with their vocal coaches), report a limited vocal range, frequent vocal fatigue and strained vocal quality prior to diagnosis and subsequential release of tongue tie. 

As a side note, a tongue does not have to be completely restricted to the tip to impact vocal quality or resonance. Oral ties are assessed over a spectrum of restriction, so even a 20% restricted tongue could impact speech, singing, sleep, or eating. Almost any degree of restriction can cause most of the common symptoms. In fact, for nursing babies, the less obvious tongue restrictions (posterior tongue-tie) often cause more nursing pain for mothers. 

While professional singers might be trained to hold the tongue's positioning low in the mouth during operatic performances, for instance, Myofunctional Therapy teaches proper lingual, labial and mandibular positioning during rest, and also during daily functions such as breathing and swallowing. Myofunctional Therapy does not target the “larynx” directly, but rather strengthens the muscles of the face and throat to better support proper functioning and reduce tension that could be impacting the larynx. Significant improvements in technical qualities of the voice are often reported post-frenectomy. The professional singers that we have worked with have reported significant improvements following their tongue tie release. They attribute the process of Frenectomy combined with Myofunctional Therapy to be the "key" that unlocked greater vocal ability and led them to the greatest success in their careers.

It is important to understand the distinction between voice lessons, vocal coaching, and voice therapy as they serve very different purposes and focus on distinct aspects of vocal development. When rehabilitating the voice following trauma or surgery, it is important to complete a course of Voice Therapy PRIOR to resuming voice coaching or voice lessons.

Here's a brief description of the differences between these three:

Voice Lessons:

• Purpose: Voice lessons primarily aim to teach individuals how to sing or use their voice effectively for musical or artistic purposes.
• Instructor's Role: A voice teacher or vocal instructor provides guidance on vocal techniques, breathing, pitch, tone, and overall singing performance.
• Focus: The focus of voice lessons is on developing musicality, expanding vocal range, and improving singing skills.
• Participants: Voice lessons are typically sought by singers, both beginners and experienced, who want to enhance their singing abilities.

Vocal Coaching:

• Purpose: Vocal coaching is geared towards helping individuals refine their singing or speaking skills for specific performances or projects.
• Instructor's Role: A vocal coach works closely with the individual on aspects such as interpretation, expression, style, and stage presence.
• Focus: The focus of vocal coaching is on preparing for auditions, recording sessions, stage performances, or specific vocal challenges.
• Participants: Singers, actors, or public speakers often seek vocal coaching to fine-tune their vocal delivery for specific events or roles.

Voice Therapy (only done with a Speech-Language Pathologist -SLP):

• Purpose: Voice therapy is a therapeutic process designed to address and treat voice-related disorders, injuries, or dysfunctions.
• Clinician's Role: A speech-language pathologist (SLP) or voice therapist assesses and diagnoses voice issues and develops a customized treatment plan.
• Focus: Voice therapy concentrates on rehabilitating or improving vocal health, treating conditions like vocal nodules, hoarseness, or voice fatigue.
• Participants: Individuals with voice problems, such as singers with vocal injuries, actors with voice strain, people experiencing voice disorders, people recovering from vocal surgery (such as vocal nodules), or people recovering from an Oral Surgery (such as Tongue Tie Surgery/Frenectomy) seek voice therapy to restore or enhance their vocal function.

While Voice Lessons focus on musical and singing skills, vocal coaching is geared toward performance and artistry, and voice therapy is a therapeutic intervention to address voice disorders and improve vocal health. Each serves a unique purpose and is led by professionals with specialized expertise. 

THE PROCESS:

Vocal surgery, although performed to alleviate specific issues, can cause significant stress and strain on the vocal folds, the voice box (larynx), the pharynx, and other associated muscles used for the purpose of singing. The trauma inflicted during surgery, coupled with the subsequent healing process, can result in a range of challenges for a singer, including diminished vocal strength, altered vocal timbre, reduced range, and even the risk of permanent damage to the overall vocal pedagogy. 

For singers who have undergone any form of vocal surgery, whether it be the removal of vocal nodules or an oral surgery such as a frenectomy to release a tongue tie, the journey to recovery can be a daunting one. These surgical procedures, while often necessary to address vocal issues or other oral concerns, can leave a singer's voice and vocal apparatus in a state of trauma. This is where the importance of Voice Therapy becomes absolutely imperative.

The Importance of seeking Voice Therapy from a Speech Pathologist prior to resuming voice lessons:

Before a singer can resume voice lessons after vocal trauma such as a vocal surgery, they must first go through the process of voice therapy, which can only be offered by a Speech Language Pathologist (SLP). You would never allow your exercise trainer from the gym to provide rehabilitative exercises on your knee following a knee surgery. Similar to how one must seek Physical Therapy to rehabilitate a knee or a neck following a knee or neck surgery, so must a singer seek voice therapy to rehabilitate and prepare the voice for regular activities to avoid re-injury or permanent damage. It is important to find a skilled and experienced Licensed Speech Pathologist to work with.

During Voice Therapy, an SLP will focus on:

1. Recovery and Rehabilitation: Voice lessons and vocal coaching provide a controlled environment for singers to gradually redevelop their vocal abilities. Professionals in this field are trained to work closely with post-surgery patients, ensuring that vocal exercises are both safe and effective. The primary goal of these sessions is to rehabilitate the voice gently. Coaches and teachers design personalized programs that respect the healing process, gradually reintroducing vocal exercises to prevent further trauma.

2. Muscle Strengthening: These therapies focus on strengthening the muscles that surround the vocal folds, voice box, larynx, pharynx, and other related muscles. Strengthening these muscles is essential for restoring vocal power and control.

This process typically takes anywhere between 3-6 months to adequately and safely prepare you to resume regular singing, lessons and coaching. 

Once your SLP discharges you from Voice Therapy, vocal lessons/coaching can safely resume. 

Voice Lessons/Coaching will focus rebuilding your new voice with skills such as:

1. Breath Control

2. Pitch Control

3. Resonance Management

4. Articulation and Diction

5. Range Expansion

6. Technique Refinement

7. Avoiding Additional Trauma

8. Preventing Permanent Damage

9. Confidence and Performance

Many of our patients have noted improvements in their singing with Myofunctional Therapy & Voice Therapy post Frenectomy and/or Vocal Surgery. With around 25% of the population affected by a tongue restriction, there are many in the professional singing world who could benefit from releasing a restricted tongue and probably don’t realize it yet. 

It is important to note that most Myofunctional Therapists do not specialize in working with professional singers, as it is truly a “niche within a niche”. There are many providers who offer “Myofunctional Therapy” who are not licensed to provide Voice Therapy. From a “scope of practice” perspective, Voice Therapy is ONLY provided by Speech Pathologists (SLPs). It is important to find a Licensed Speech Pathologist who specializes in Myofunctional & Voice Therapy specifically for Professional Singers. 

We also provide Voice Therapy for clients of all ages who are experiencing Vocal Pathology such as Hoarseness, Vocal Nodules and more. 

We will provide a thorough assessment and come up with a plan. If it is found that you do have an oral restriction impacting function (tongue tie), we will refer you to the best specialized release providers and begin to prepare you for the frenectomy procedure.  We collaborate closely with your release provider, ENT and vocal coach throughout the process. As with any myofunctional client, it is crucial for voice clients to receive Pre-Frenectomy Therapy for several weeks before jumping into any vocal surgery or release. 

When it comes to voice, it is very important to work closely with a therapist who can determine when you are ready for the release and guide you through the Post-Frenectomy Vocal/Myo Program to help you achieve optimal long term results. Most SLP's do not have this additional focused training. It is important to find an SLP who specializes in Myofunctional Therapy and Voice Therapy to help guide you.

If you are a singer or interested in improving your voice, contact me to set up a consultation.