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Brisbane Voice Clinic

Evidenced-Based Treatment of:

– Difficulties with your speaking voice
– Difficulties with your singing voice
– Chronic Cough
– Paradoxical Vocal Fold Movement (PVFM)  or Vocal Cord Dysfunction (VCD)
– Exercise Induced Laryngeal Obstruction

We use the lingWAVES Voice Protocol for Calibrated and Precise Voice Analysis 

The lingWAVES system is used by universities and clinics around the world for voice therapy and research. 

 

 

Our Services Include:

– Saturday appointments
Video-conferencing/Tele-health for patients in regional and remote Australia 

 

Services for Children (6 years +) and Adults 

We are pleased to provide services for  children aged 6 years+ (voice, chronic cough and PVFM/VCD only) and for adults

 

Contact Us!

Conveniently Located within the Headache Neck and Jaw Clinic in Nundah

A: 2/1471 Sandgate Road, Nundah QLD 4012

E: elizabeth.savina@loqui.com.au 

P: 0410 114 490           F: 07 3144 5617

PARKING: We recommend you park on Robinson Rd, the left hand turn just north of the Go-Gecko

 

Appointments Available: 
Tuesdays: 9:00- 5:30pm
Saturdays: 9:00am – 4:00pm 

 

We can help you develop 
a clearer voice,
a stronger voice,
a voice that is effortless,
a voice that lasts longer,
a wider pitch range,
the pitch that feels right to you 

Funding Options                                                                                             

We Can Provide Services for: 

Workcover and DVA 
– Billed directly, generally no fee for the client  

Home Care Package funding managed by organisations  such as Burnie Brae, Bolton Clarke, Blue Cross      
– Billed directly, generally no fee for the client

Medicare Chronic Disease Management Plan
–  
These are for conditions lasting > 6 months, and you need to ask for an appointment for a Chronic Disease Management plan when booking the appointment with your GP. 
–  It provides a rebate of $53.80/session
–  The session fee ($190/$140) is paid in full by the client on the day and a HICAPS refund is processed immediately. 

Private Health Funds 
– Initial Appointment item number is 320,
– Subsequent appointments are item number: 340 
– The claim is processed via HICAPS and gap is paid for by client on the day. 

NDIS 
     
We are registered providers of Therapeutic Supports. Brisbane Voice Clinic supports NDIS participants and consults under the rates outlined in the NDIS Price Guide.  Supporting NDIS participants requires additional reporting, planning and NDIS service agreements. Service agreements, planning and costings will be discussed at the time of booking. 

 

1) For Patients with Voice Difficulties/Any Changes to their Voice:

– Imaging of your larynx (voice-box) by an ENT, preferably with stroboscopy (this allows the best visualisation of the vocal cords). 
– We need to receive the ENT report (and video whenever possible) before we can give a patient any vocal exercises.

2) For Patients with Chronic Cough or Paradoxical Vocal Cord Movement (PVFM)/ Vocal Cord Dysfunction VCD 

-Diagnosis of Chronic Refractory Cough  or VCD/PVFM by an ENT or Respiratory Specialist. We appreciate receiving reports of laryngeal imaging, or other testing, such as respiratory function tests. 
-If there are voice changes along with the Chronic Cough/PVFM we require patients to have had imaging of their larynx before we give any vocal exercises.

3) For Patients with Swallowing Difficulties

 -We appreciate receiving reports of any relevant investigations and comprehensive health summaries. If no investigations have yet occurred, our assessment can assist in determining the most appropriate instrumental assessment of swallowing. 

4) If you seeking presentation skills or voice training, you do not need to have seen an ENT.  

We ask you to complete a case history form prior to coming to us so that we can maximise our time with you.

In your first appointment we will:

  • Check aspects of your case history
  • Conduct a voice assessment, taking recordings with research-grade equipment and software
  • Conduct an assessment of your posture, head /neck musculature, and breathing patterns
  • Identify and teach exercises and stretches that will improve your voice (these will be emailed to you)
  • Provide manual therapy (massage) if it is likely to be helpful
  • Provide personalised information about voice care, including equipment and environmental modifications (this will be emailed to you)

Home Exercises 

We will usually give you exercises that initially only take 1-2 minutes, however we ask that you complete them 3-5 times/day 5-7 days/week. At first you will need to give all of your attention to the exercises, however, with practice, they can be done while doing other tasks.

At review appointments we will get you to show us how you are completing your exercises and we will then refine or give more complex exercises.

 

This will vary with the:
– diagnosis, and severity/complexity of your voice difficulties, 
– how long you have had the voice difficulties for and,
– your vocal requirements (e.g. singing/lecturing/working in background noise) 

The research and our experience suggests most people will achieve their goals in 4-6 sessions. You should notice some improvements within the first two sessions. 

There are some programs for specific diagnoses (e.g. Parkinson’s Disease) that require a greater intensity and number of sessions. 

 We are able to assist with the following issues: 
  • Muscle Tension Dysphonia (MTD) 
  • Vocal Fold Nodules/Polyps/Granulomas
  • Vocal Fold Palsy/Paralysis
  • Spasmodic Dysphonia
  • Vocal Tremor
  • Presbyphonia -Voice changes associated with ageing. 
  • Puberphonia – Voice not changing during adolescence despite growth in the larynx
  • Voice changes due to menopause/hormonal changes
  • Pre & Post Surgical Voice 
  • Voice issues issues due to neurological, connective tissue and/or neuromuscular, conditions  

We can help you develop 
a clearer voice,
a stronger voice,
a voice that is effortless,
a voice that lasts longer,
a wider pitch range,
the pitch that feels right to you 

Speech Pathologists receive extensive training in the anatomy and neurological control of the mouth, throat, larynx and of eating, drinking and swallowing

Speech Pathologists can help people who have difficulties with:
– chewing their food. 
– controlling fluids within the mouth
– foods getting stuck in the throat. 
– food or drink going down the wrong way causing coughing
– sensation of lump in the throat (after appropriate investigations) 
– increased effort with swallowing 

Speech Pathologists receive extensive training in the anatomy and neurology of the larynx; This is where chronic dry cough generally originates. Research has shown that Speech Pathologists can can teach several strategies that help patients to eliminate their dry cough.

Occasionally patients may also require medication alongside the therapy.  Below provides a brief overview of how a Chronic Dry Cough can develop and how we can treat it.

 

Where are your Vocal Folds?                

Your Voice Box (Larynx) sits at the top of the airway. Sitting inside the Vocal Folds (sometimes also called vocal cords)

 

The resting position of the vocal folds is OPEN – while we are breathing in and out.

 

Here is a video of the vocal folds during voicing and breathing.

                                       

Our Vocal Folds are Lifesavers!   

The Vocal Folds act like sliding doors that CLOSE the airway to

  • stop food and drink or reflux going down into our lungs

  • cough up any mucous/phlegm

  • stabilise us when we need to do heavy work

  • create voice for talking/singing/laughing

  • stop us breathing momentarily when we are frightened (freeze before flight or fight)

 The Vocal Folds’ Closure is usually a reflex – it can happen very quickly without us telling them to. This is because it is often meant to save our life!!!

Sometimes They Get a Bit too Keen!

Imagine you’ve got a cut on  your hand. If you touch the part of your hand that is cut – it hurts!  But if you touch another part of your hand – it feels fine! So exactly the same input/stimulus is treated as a threat if there has already been some damage.

Dry Coughing happens because the larynx thinks there is a threat, when there isn’t really one.

 

Damage or irritation of the vocal folds can come from

  • Reflux

  • An upper respiratory tract infection

  • Frequent “dry”  coughing or throat clearing

  • Straining or over-closing the vocal folds while talking

  • Breathing in chemicals or dust

There are changes that happen in the brain and in the larynx when our body has been hurt.

Normal sensations that can be perceived as a threat include

  • the closure of the vocal folds during talking/laughing

  • the passage of air while breathing more deeply than usual (such as when exercising or about to laugh)

  • normal levels of perfume/smells/fumes

 

We can reverse these changes.
We can get control of the vocal folds and teach them to calm down and only close when they really need to.   

 

Your Speech Pathologist is going to focus on five main things:

 

  1. Teach you cough suppression techniques – these stops the cough and puts you in control

  2. If needed, teach you voice exercises to improve your voice so that it is not a cause of damage to your vocal folds.  

  3. Identify what might be causing damage to the vocal folds (if this is not known) help you figure out ways to reduce the damage to the vocal folds

  4. Help you identify your triggers (if not known) and how you might be able to reduce them

  5. Advice on managing reflux

 

Vocal cord dysfunction occurs when the vocal folds close when they should be staying open – most often when someone is trying to breathe in.

Where are your Vocal Folds?                

Your Voice Box (Larynx) sits at the top of the airway. Sitting inside the Vocal Folds (sometimes also called vocal cords)

The resting position of the vocal folds is OPEN – while we are breathing in and out.

Here is a video of the vocal folds during voicing and breathing.

                                      

Our Vocal Folds are Lifesavers!   

The Vocal Folds act like sliding doors that CLOSE the airway to

  • stop food and drink or reflux going down into our lungs

  • cough up any mucous/phlegm

  • stabilise us when we need to do heavy work

  • stop us breathing momentarily when we are frightened (freeze before flight or fight)

That we can also use them to talk, laugh and sing is an extra bonus!

The closure is usually a reflex. It can happen without us telling them to. This is because it is often meant to save our life!!!

Sometimes They Get a Bit too Keen!

When parts of our body are have been damaged, a natural part of healing process is to lock down and guard the area for a certain amount of time (muscles get tense).

This is to protect the area from any further damage, this can include over-reacting to normal sensation

Paradoxical Vocal Fold Motion is when the vocal folds close when they shouldn’t. This is usually because there has been some kind of temporary damage. They then think normal sensations are threats to the lungs.

Damage or irritation of the vocal folds can come from

  • Reflux

  • An upper respiratory tract infection

  • Frequent “dry”  coughing or throat clearing

  • Straining or over-closing the vocal folds while talking

  • Breathing in chemicals or dust

  • Post Nasal Drip

 

There are changes that happen in the brain and in the larynx when our body has been hurt.

Normal sensations that can be perceived as a threat include

  • the closure of the vocal folds during talking/laughing

  • the passage of air while breathing more deeply than usual (such as when exercising or about to laugh)

We can reverse these changes.
We can get control of the vocal folds and teach them to calm down and only close when they really need to.   

 

Your Speech Pathologist is going to focus on five main things:

  1. Help you tune in to your body to identify the very start of an episode

  2. Teach how to Voluntarily Open Up the Vocal Folds (Breathing Recovery Strategy)

  3. If needed, teach you voice exercises to improve your voice so that it is not a cause of damage to your vocal folds.  

  4. Identify what might be causing damage to the vocal folds (if this is not known) help you figure out ways to reduce the damage to the vocal folds

  5. Help you identify your triggers (if not known) and how you might be able to reduce them

     

 

 

Exercise Induced Laryngeal Obstruction  occurs when the vocal folds close when they should be staying open – most often when someone is trying to breathe in. It is similar to Vocal Cord Dysfunction but tends to only occur during exercise/exertion. It often occurs when athletes step up a grade in their training

Treatment includes
– identifying and mitigating any contributing factors/triggers (e.g. reflux, chemicals,  weight training technique)  
– implementing special breathing techniques that open up the vocal folds so that the person can continue with their exercise. 

We have partnered with a local gym so that we can practice the techniques on treadmills/bikes rowing machine. We are also happy to attend swimming practice or sports training sessions/games.  

Where are your Vocal Folds?                

Your Voice Box (Larynx) sits at the top of the airway. Sitting inside the Vocal Folds (sometimes also called vocal cords)

The resting position of the vocal folds is OPEN – while we are breathing in and out.

Here is a video of the vocal folds during voicing and breathing.

                                      

Our Vocal Folds are Lifesavers!   

The Vocal Folds act like sliding doors that CLOSE the airway to

  • stop food and drink or reflux going down into our lungs

  • cough up any mucous/phlegm

  • stabilise us when we need to do heavy work

  • stop us breathing momentarily when we are frightened (freeze before flight or fight)

That we can also use them to talk, laugh and sing is an extra bonus!

The closure is usually a reflex. It can happen without us telling them to. This is because it is often meant to save our life!!!

Sometimes They Get a Bit too Keen!

When parts of our body are have been damaged, a natural part of healing process is to lock down and guard the area for a certain amount of time (muscles get tense).

This is to protect the area from any further damage, this can include over-reacting to normal sensation

Exercise Induced Laryngeal Obstruction is when the vocal folds close when they shouldn’t. This is usually because there has been some kind of temporary damage. They then think normal sensations are threats to the lungs.

Damage or irritation of the vocal folds can come from

  • Reflux

  • An upper respiratory tract infection

  • Frequent “dry”  coughing or throat clearing

  • Straining or over-closing the vocal folds while talking

  • Breathing in chemicals or dust

  • Post Nasal Drip

There are changes that happen in the brain and in the larynx when our body has been hurt.

Normal sensations that can be perceived as a threat include

  • the closure of the vocal folds during talking/laughing

  • the passage of air while breathing more deeply than usual (such as when exercising or about to laugh)

We can reverse these changes.
We can get control of the vocal folds and teach them to calm down and only close when they really need to.   

 

Your Speech Pathologist is going to focus on five main things:

  1. Help you tune in to your body to identify the very start of an episode

  2. Teach how to Voluntarily Open Up the Vocal Folds (Breathing Recovery Strategy)

  3. If needed, teach you voice exercises to improve your voice so that it is not a cause of damage to your vocal folds.  

  4. Identify what might be causing damage to the vocal folds (if this is not known) help you figure out ways to reduce the damage to the vocal folds

  5. Help you identify your triggers (if not known) and how you might be able to reduce them

     

 

About Our Team

Elizabeth Savina, BSpPath (Hons I), CPSP*

Member of the Laryngology Society of Australasia & Australian Voice AssociatioN, STeering Committee of the Qld Voice Special interest group 

Elizabeth has extensive clinical skills in the assessment and treatment of voice disorders. She collaborates with, and contributes to, statewide groups and national organisations. Together with Bernadette Dutton, she manages the Brisbane Voice Clinic. She has over 18 years experience working as a Speech Pathologist. 

Elizabeth has particular interest in Voice therapy for Performers and voice and swallowing difficulties in older adults. Elizabeth conducts a community choir, Chunky Harmonies, and is a skilled singer, musician (guitar, mandolin) and performer with a special interest in rock/folk/celtic/bluegrass.

Elizabeth has undertaken further professional development in the area of voice including training in: 
– Myofascial Release  and Vocal Unloading which are styles of massage focusing on the area around the larynx
– Estill Voice Training – obtaining her Certificate of Figure Proficiency in 2012
Lessac-Madsen Resonant Voice Therapy (LMRVT) and Casper-Stone Condifdential Flow Therapy (CSCFT)

In 2014 she was awarded Outstanding Contribution to the Australian Voice Association. In 2017 she provided consultancy to researchers from the Queensland Conservatorium of Music, Griffith University, on the Asia-Pacific Sing to Beat Parkinson’s project and ran the singing group the Red Hot Chilli Parkies. 

Elizabeth regularly practices mindfulness and techniques from ACT (Acceptance and Commitment Therapy)

International, National & State Presentations include:

– Steam, Straws and Stroboscopy –  An Update on Voice Care (2019) National Choralfest, Perth, WA. 
– Promoting Vocal Safety in Singing Groups for People with Parkinson’s Disease (2018) Sing to Beat Parkinson’s Asia-Pacific Symposium
Steam, Straws and Earplugs: How to look after your Voice (2016) Woodford Folk Festival
– Semi-occluded Tract Exercises for Voice Therapy (2014) and Vocal Function Exercises (2015) Qld Voice SIG
– Mirror Neurons in Vocal Pedagogy (2013) International Congress of Voice Teachers

BACHELOR OF SPEECH PATHOLOGY (Hons I). CERTIFIED PRACTISING Speech Pathologist, MEMBER OF SPEECH PATHOLOGY AUSTRALIA. 

 

Bernadette Dutton  BSpPath, CPSP*

Member of the Australian Voice Association. 

Bernadette Dutton, Principal of Loqui Speech Pathology is a qualified speech pathologist, highly experienced in the assessment and management of voice disorders, chronic refractory cough,  VCD/PVFM and voice therapy for professional voice users.

Bernadette brings to the clinic more than 20 years voice experience, having worked as a senior ENT speech pathologists in both outpatient and inpatient tertiary hospital settings.

Bernadette has managed voice diagnostic, voice therapy and spasmodic dysphonia clinics. She is also a clinical educator at the University of Queensland and Australian Catholic University voice clinics. 

Bernadette sings in a Brisbane choir and conducts a Wellness Choir for seniors and people with neurological conditions. 

*BACHELOR OF SPEECH PATHOLOGY. CERTIFIED PRACTISING MEMBER OF SPEECH PATHOLOGY AUSTRALIA.  

Downloads and Links

1. Entire Steam-Straws-Stroboscopy: An Update on Vocal Health ANCA Choralfest 2019: All 63 Slides of the presentation. 
Links to key videos (as these don’t seem to be working from the pdf) 
Slide 7: 
Nasendoscopy/ with labelling of the anatomy. Slide 8: High Speed Digital Videolaryngoscopy. Slide 12:Swallowing Animation Slide 37: Standard Laryngoscopy Slide 38: Stroboscopy

2. Take Home Messages Steam-Straws-Stroboscopy-Choralfest 2019: The key messages and resources summarised in 9 slides. 

3. 7 Ways to Help Your Voice: Our ebook on the 7 most essential aspects of voice care: