Conversation Training Therapy for a Professional Voice User
This case demonstrates the use of conversation training therapy (CTT) in a professional voice user with phonotraumatic vocal fold lesions. CTT is a voice therapy approach based on motor learning theory that teaches patients with voice disorders the traditional therapeutic targets of phonotrauma reduction, resonance, negative practice, prosody, and breath control without the traditional therapeutic hierarchy of skill building from least to most complex. CTT exclusively relies on patient-driven conversation as the therapeutic stimulus upon which therapy skills are layered.
JB was a 47-year-old man with gradual onset of hoarseness for 6 months with no inciting events. He reported a raspy and constricted speaking voice with difficulty projecting and decreased vocal endurance. He was a middle-school reading teacher and a semiprofessional rock singer. At the time of referral, he had been singing solo and in rock bands for over 20 years with at least one performance weekly. His singing voice also had a reduction in quality with frequent voice breaks, loss of high notes, and increased effort. He reported that his voice quality was so degraded by the end of a teaching week that he has stopped scheduling Friday singing events to rest his voice for Saturday performances. He had never taken singing lessons. He attended one session of voice therapy at another facility that consisted of diaphragmatic breathing exercises, which he stated were not helpful.