Services A to Z

Recommended Literature

• From the Clinical Otolaryngology Journal, the “ 12 minute consultation” series:
• Kubba H. A child who snores. Clin Otolaryngol.  2006. 31; 317-8.
• Kubba H. Childhood epistaxis. Clin Otolaryngol. 2006. 31; 212-3.
• Kubba H. A child with cervical lymphadenopathy. Clin Otolaryngol. 2006. 31; 433-4.
• Robb PJ. Childhood otitis media with effusion. Clin Otolaryngol. 2006. 31; 535-7.
• Rainsbury JW, Aldren CP. Facial nerve palsy.  Clin Otolarynol. 2007 32; 38-40.
• Cathcart R, Wilson J. Lump in the throat. Clin Otolaryngol. 2007. 32; 108-10.
• Montague ML, Hussain SS. A child with recurrent acute otitis media. Clin Otolaryngol. 2007 32; 190-2.
• Kubba H. An infant with stridor. Clin Otalaryngol. 2007. 32; 283-4.
• Leong AC et al. Sudden hearing loss. Clin Otolaryngol. 2007. 32; 391-4.
• McKean SA, Hussain SS. Otitis externa. Clin Otolaryngol. 2007. 32; 457-9.
• Lloyd SK, Baguley DM. A patient with tinnitus. Clin Otolaryngol. 2008. 33; 25-8.
• Nagala S, Wilson J. Chronic cough. Clin Otolaryngol. 2008. 33; 94-96.
• Broomfield SJ et al. The dizzy patient. Clin Otolaryngol. 2008. 33; 223-7
• Geyer M, Nilssen E. Evidence-based management of a patient with anosmia. Clin Otolaryngol. 2008. 33; 466-9. 
• Cathcart R, Wilson J. Catarrh: an evidence-based approach to the 12 min consultation. Clin Otolaryngol. 2008. 33; 352-3.
• Syed I et al. Hoarse voice in adults: an evidence-based approach to the 12 minute consultation. Clin Otolaryngol. 2009. 34; 54-8
• Fraser L, Kelly G. An evidence-based approach to the management of the adult with nasal obstruction. Clin Otolaryngol. 2009. 34; 151-5.
• Little SA et al. An evidence-based approach to the child who drools saliva. Clin otolaryngol. 2009. 34; 236-9
• Glore RJ et al. A patient with dry mouth. Clin Otolaryngol. 2009. 34; 358-63
• Isa AY, Hilmi OJ. An evidence based approach to the management of salivary masses. Clin Otolaryngol. 2009. 34; 470-3.
• Yaneza MM et al. 12 minute consultation: a patient with nasal crusting. Clin Otolaryngol. 2010. 35; 313-20.
• Visvanathan V, Kelly G. 12 minute consultation: an evidence-based management of referred otalgia. Clin Otolaryngol. 2010. 35; 409-14.
• Kamani T, Jones NS. 12 minute consultation: evidence based management of patient with facial pain. Clin otolaryngol.  2012. 37(3); 207-212.
• Malik V et al. An evidence based approach to the 12 minute consultation for a child with downs syndrome. Clinical otolaryngol. 37(4); 291-296.
• Lawrence R, Bateman N. 12 minute consultation: an evidence based approach to the management of a child with a speech and language delay. Clinical Otolaryngol. 2013. 38 (2) 148-153.
• Al-Hussaini A et al. 12 minute consultation: an evidence based approach to the management of dysphagia. Clin Otolaryngol. 2013. 38(3); 237-243

Other recommended literature

• Sullivan FM et al. Early treatment with Prednisolone or Acyclovir in Bell’s Palsy. NEJM 2007. 357; 1598-1607. Full text available for download on the net.
• Phillips JS et al. Evidence review and ENT-UK consensus report for the use of aminoglycoside-containing ear drops in the presence of an open middle ear. Clin Otolaryngol. 2007. 32;    330-6
• Thomas M, et al.  EPOS Primary Care Guidelines: European position paper on the primary care Diagnosis and management of Rhinosinusitis and nasal polyps 2007-a summary. Primary care respire J. 2008. 17(2): 79-89 Full text available for download on the net.
• Jones N.  Classification and diagnosis of facial pain. Hospital Medicine 2001. Vol62(10);598-606

List compiled by: Mr A Tsikoudas, Consultant ENT surgeon, January 2016

General

ENT Examination

Otology

Rhinology

ENT Radiology

List compiled by: Mr A Tsikoudas, Consultant ENT Surgeon, May 2016

In NHSGGC we work across different environments including health centres, hospitals, care homes, and if required we can also visit you in your own home. There are options for video and telephone consultations with you and/or your loved ones when this is appropriate.

We work with patients experiencing swallowing and communication difficulties related to various conditions including:

· Progressive neurological conditions such as Parkinson’s Disease, Dementia, Motor Neuron Disease

· Stroke and Brain Injury

· Stammer/Dysfluency

· Head & Neck Conditions/Cancer

· Voice Disorders

We also work with the family/carers of our patients to support them and their understanding of swallowing and communication difficulties.

There are Speech and Language Therapy teams across Glasgow and the surrounding areas. If you need to contact us for help, advice, or to arrange or cancel an appointment then please phone your local department on the number below.

In-patient or Out-patient services

· Queen Elizabeth University Hospital/ Langlands Unit 0141 451 6368/ 0141 201 2887

· Glasgow Royal Infirmary 0141 201 6467

· Gartnavel General Hospital 0141 211 3027

· Stobhill Hospital/ Lightburn Hospital 0141 355 1613

· Inverclyde Royal Hospital/ Larkfield Unit 01475 505023

· Royal Alexandra Hospital 0141 314 6117

· The New Victoria Hospital 0141 347 8660

Learning Disability Teams

North East Learning Disability SLT Team 0141 201 4109  

North West Learning Disability SLT Team 0141 232 1340

South Learning Disability SLT Team 0141 276 2334

Rehabilitation Services

North West Rehabilitation Service 0141 201 2705

North East Rehabilitation Service 0141 201 3210

South Rehabilitation Service 0131 232 7174

Aphasia is a communication disorder that can affect your ability to process language.

You may have difficulty with:

• Understanding the words that people say to you
• Speaking
• Understanding written words/reading
• Writing and spelling

Aphasia (also known as dysphasia) is caused by damage to the areas of the brain responsible for language. The level of communication difficulty varies from patient to patient depending on the location and amount of damage to the brain. Aphasia can result from a variety of disorders including stroke, head injury and brain tumours. It may also be caused by surgery or other diseases which affect the brain, such as dementia.

What is the role of the SLT?

A Speech and Language Therapist will complete a communication assessment. This helps us understand what areas of communication you need help with. We may work directly with you to improve your communication skills via therapy. This will help you to communicate needs, thoughts and feelings. We may also consider alternative means of communication including picture and word books. We will also support and advise your family and hospital staff how best to support your communication.

Dysarthria is a speech disorder where the speech muscles become weak, stiff or uncoordinated. Dysarthria can make it difficult for you to produce sounds, words and sentences when you speak. There are different causes of dysarthria which include stroke, head injury, Parkinson’s disease, Motor Neurone Disease, Multiple Sclerosis and oral surgery.

If you have dysarthria you may have difficulties with:

• moving your tongue and lips
• breathing co-ordination
• voice
• back of throat (speech may sound nasal, as if you have a cold, or air may escape from your nose)
• rate of speech

At times it may be difficult for people to understand what you’re saying and this can be frustrating.
We may consider the use of a communication aid to support existing speech and help with this. This could be a communication book with words and pictures, an alphabet chart or an electronic aid with built-in voice. If appropriate, we can discuss these options with you.

Stammering (dysfluency) is a communication difficulty which causes a disruption to the flow of speech. Each patient’s stammer affects them in a different way and this can vary from day to day. Some features of stammering include:

• repetition of sounds, syllables words or phrases
• silent pauses
• disrupted breathing patterns
• stretching sounds out
• avoiding words or situations
• physical tension around the face, mouth and rest of the body

Voice disorders are a range of conditions which affect the voice box (larynx). Voice problems including hoarseness are called dysphonia, or if there is a complete loss of voice this is called aphonia. Some voice disorders can affect the way the voice sounds. For, example, your voice can sound hoarse, croaky, strained, breathy or weak. Voice disorders can also make your throat feel different, for example it might feel sore, achy or dry. Patient’s of all ages can develop a voice disorder however it is often due to a combination of factors which can include:

• Smoking
• Some medical conditions
• Excessive talking or shouting
• Stress

As SLTs we have an important role in helping you with your voice disorder. After seeing an Ear, Nose and Throat (ENT) Doctor, you may be referred to speech and language therapy for a voice assessment and therapy

The Speech and Language Therapy service provides assessment, advice and therapy for patients with communication and swallowing difficulties resulting from head and neck cancer and/or its treatment.

We are core members of the head and neck cancer multidisciplinary team (MDT). If you are referred to our service, the SLT team will be involved in your care throughout your treatment. SLT involvement often begins at the point of diagnosis when you will be given information and advice before you start your treatment, and continues through to the rehabilitation of speech, voice and/or swallow after your treatment has finished. For people living outside of the Greater Glasgow and Clyde area, we will work with your local SLT team to ensure a smooth transition of care if this takes place elsewhere. SLTs can offer assessment, support and advice for patients under the Palliative Care Team who experience communication and/or swallowing difficulties.

The Head and Neck Speech and Language Therapy Team also provide support for patients who experience speech, voice and/or swallowing difficulties as a result of their cancer treatment which may occur many years after the head and neck cancer has been treated.

The term AAC is used to describe the different methods that can be used to help people with communication difficulties communicate with others. Some kinds of AAC are part of how everyone communicates: for example, waving goodbye; giving a ‘thumbs up’ instead of speaking; pointing to a picture, or gesturing in a foreign country.

However, some patient’s with speech difficulties have to rely on AAC most of the time. Some AAC tools “add on” to verbal communication – simple methods such as pictures, gestures and pointing.

Some patients need more complex help to communicate, such as powerful computer technology including iPADs.

Speech and Language Therapists can assess your communication skills and explore the options of AAC to establish if this would be beneficial.

Dysphagia is the medical name for difficulty with swallowing. As SLTs we are experts in swallowing problems. We assess the safety and efficiency of your swallow function and can give advice on how to manage these difficulties including suggesting ways to modify or change what you eat and drink. We may recommend you change the consistency of your drinks as thicker drinks travel more slowly and may be easier to swallow depending on the nature of the swallowing difficulty. Drinks are thickened using a ‘thickening agent’. We may recommend you change the consistency of your foods, this may be to softer options that are easier to chew.

Here is some general advice which you may find useful to help with your swallow:

• Sit in an upright position.
• Take time to eat and drink.
• Chew food well and ensure your mouth is empty before taking another mouthful.
• Try to eat in a quiet environment to reduce distractions e.g. turning off the T.V.
• Take regular sips of fluid to help clear any food left in your mouth or throat.

Your SLT can give specific guidance regarding these or other strategies that may help you, after a formal swallow assessment.

If you have a swallowing problem, you may be invited to attend a videofluoroscopy examination by your SLT.
A videofluoroscopy is a swallow assessment that uses moving x-rays to study what happens to food and/or drink when you swallow. The clinic is run by two specialist Speech and Language Therapists and a radiographer. There may be students or other professionals present to observe/assist with the clinic. You will be seated in front of an x-ray machine and we will ask you to swallow different kinds of food and/or drinks of different consistencies. You may find the taste unusual because a contrast (a special liquid/powder that shows up on X-rays) is added to the food and drink. The videofluoroscopy will take place in the x-ray department of the hospital stated in your appointment letter or the hospital at which you are an in-patient.

The International Dysphagia Diet Standardisation Initiative (IDDSI) Framework is a set of descriptions that can be used all over the world. These are used to describe different textures of food and drink for people with swallowing problems

Level 0 Fluids (normal)
The consistency of water. This consistency flows freely. Can drink this via any teat/nipple, cup or straw as appropriate for age and skills.  

Level 1 fluids (slightly thick)
Thicker than water. Requires a little more effort to drink than Level 0. Flows through a straw, syringe, teat/nipple. This consistency flows at a slower rate than Level 0 therefore can give you better control of the fluid.  

Level 2 fluids (mildly thick)
This consistency flows off a spoon. It is shippable, pours quickly from a spoon but slower than Level 0 or Level 1 fluids. It requires mild effort to drink this thickness through a standard straw. This consistency flows slower than Level 0 and Level 1 fluids.  

Level 3 fluids (moderately thick)/ Level 3 diet (liquidised)
This consistency can be drunk from a cup. This consistency requires a moderate effort to be suck through a straw. It cannot be pipped, layered or moulded on a plate because it will not retain its shape. It cannot be eaten with a fork because it drips slowly through the prongs. It can be eaten with a spoon. This consistency requires or chewing and it can be swallowed directly. Example of Level 3 diet/fluids could be a yoghurt, custard or smooth soup.  Click here to see how to make Level 3 peaches.

Transitional Foods
Transitional foods start as one texture (e.g. firm solid) and change into another texture specifically when moisture (e.g. water or saliva) is applied, or when a change in temperature occurs (e.g. heating)

Testing Method:
If you are unsure whether your food is a transitional food, you can test it using the fork pressure test:
After moisture or temperature has been applied, the sample can be easily deformed and does not recover its shape when force is lifted Examples of transitional foods include ice-cream, jelly, wafers. Some specific crackers or cookies that are made to dissolve easily in the mouth

Level 4 Diet (Puree)
This is food that has been pureed or has puree texture. It does not require chewing and holds its shape on a plate or when scooped. It falls from a spoon in a single spoonful when tilted and it can be piped, layered or moulded. It is smooth throughout with no ‘bits’. Click here to see how to make Level 4 peaches.

Level 5 Diet (Minced and moist)
This is food that is soft and moist, but with no liquid leaking or dripping from the food. Biting is not required and it only requires minimal chewing. Lumps should be no bigger than 4mm in size for adults or 2mm for a child. The food can be easily mashed with just a little pressure from a fork. You should be able to scoop food onto a fork, with no liquid falling off the fork. Click here to see how to make Level 5 peaches.

Level 6 Diet (Soft and bite sized)
This is food that is soft, tender and moist, but with no thin liquid leaking or dripping from the food. The ability to “bite-off” a piece of food is not required but the ability to chew “bite-sized” pieces so that they are safe to swallow is required. The bite-sized pieces should be no bigger than 15mm x 15mm in size for adults or 8mm x 8mm for children. This food can be mashed or broken down with pressure from a fork. A knife is not required to cut this food. Click here to see how to make Level 6 peaches.

Level 7 Easy to Chew Diet
This is normal, everyday food of a soft and tender texture. Food piece size is not restricted in Level 7 Easy to Chew, therefore foods may be a range of sizes. You should be able to “bite off” pieces of soft and tender food and choose bite sizes that are safe to chew and swallow. You should be able to chew pieces of soft and tender food, so they are safe to swallow without tiring easily. This level still avoids hard, tough, chewy, fibrous, stringy, dry, crispy, crunchy or crumbly food pieces.

Our dieteitc colleauges have some informative videos regarding modified diet and fluids here.

What is Stroke?

A stroke is when the blood supply to a part of your brain is interrupted by a blood clot or bleed which causes damage to your brain cells.  A stroke can affect you differently depending on which part of your brain was involved and how severe the stroke was. Some of the most common effects are weakness or paralysis down one side of your body, difficulty communicating, difficulty swallowing, visual problems and issues with memory and concentration.

What is the role of the SLT?

If you have had a stroke and are having difficulty with communicating and or swallowing you may be referred to the Speech and Language Therapist who will carry out assessment of these difficulties. It may then be appropriate to carry out a therapy programme as part of your rehabilitation. They may give you tasks or exercises to help improve your communication or swallowing but also give advice, support and strategies to you and your family to help cope better with these issues. The therapy will be targeted specifically to your individual needs. You are most likely to be seen by the SLT while in hospital but you can also be seen when you are discharged home either in your own home or in an outpatient clinic. 

What is Dementia?

‘Dementia’ is an umbrella term which describes a variety of symptoms, such as memory loss, slower thinking, changes in behaviour and mood, and difficulties with language and understanding. Dementia is progressive, which means that symptoms will get worse over time however the rate of this varies from patient-to-patient.

There are many causes of dementia but it is important to remember that dementia is not a natural part of ageing. Instead it is caused when a disease damages nerve cells in the brain. Some of the most common types of dementia include Alzheimer’s Disease, Vascular Dementia, Dementia with Lewy Bodies and Frontotemporal Dementia.

What is the role of the SLT?

Communication difficulties can occur in all types of dementia. These can significantly impact the patient’s independence, relationships, emotional and physical wellbeing, and ability to participate in day to day activities. A Speech and Language Therapist can help to identify the patient’s communication needs, strengths and priorities. They will then work with the person with dementia to select the best type of intervention to help sustain these. Speech and Language Therapists may also provide education and training to families and carers about how best to support someone with communication difficulties.

As particular patterns of communication difficulties are associated with different types of dementia, Speech and Language Therapists can also help with differential diagnosis and so contribute to the diagnostic stage of treatment.

Difficulties with eating, drinking and swallowing can be common for patient’s with dementia, especially in the later stages. Speech and Language Therapists play an important role in the assessment and management of these to prevent malnutrition and dehydration, and reduce the risk of repeated chest infections, pneumonia and choking.

What is Motor Neurone Disease?

MND is the short term for Motor Neurone Disease, and is a condition that affects the brain and nerves. These nerves help tell your muscles what to do and MND causes these messages to gradually stop reaching the muscles. This leads the muscles to weaken, stiffen and waste, which can affect how we walk, talk and eat and drink. Moving around, swallowing and breathing can become increasingly difficult. Although there is no cure, there is treatment which can help reduce the impact these symptoms have on your life.

What is the role of the SLT?

Some people with motor neurone disease develop problems with their speech and swallowing. Speech and Language therapists (SLTs) can help by providing advice and sometimes equipment.  SLTs can advise on techniques to use your voice effectively and communication aids to suit you. Communication aids can range from simple tools like word or picture boards to high-tech electronic aids. If your voice weakens with MND you may wish to use your own recorded voice on devices. Voice banking enables you to record sample words and phrases that can be used as a synthesised version of your voice. This process needs to be completed as early as possible after diagnosis. If MND affects your swallow it may be harder to eat and drink. SLTs can assess your swallowing ability and help with swallowing techniques. SLTs can also advise if you have saliva problems. Such as thin saliva gathering in the mouth or thick saliva causing your mouth to feel dry or sticky.

What is Parkinson’s Disease?

Parkinson’s Disease is a progressive neurological disorder. It occurs due to a reduced amount of dopamine in the brain. Dopamine is a chemical that helps control movement.
Many patients with Parkinson’s disease experience speech difficulties. These difficulties are often described as slurred, slow speech. Some people feel the sound of their voice has changed. This is known as Dysarthria.
Additionally, swallowing can be affected in different ways in Parkinson’s disease. The muscles used to swallow in your mouth and throat can become rigid or slow to move. This can make eating and drinking more difficult. Some patients find it difficult to start a swallow, so food stays in the mouth for longer than usual before it is swallowed. This can also cause saliva to collect in the mouth and result in drooling/dribbling.

What is the role of the SLT?

The Speech and Language Therapy service provides assessment, advice and therapy for patients with communication and swallowing difficulties resulting from Parkinson’s disease. The types and severity of the problems can vary from person to person.
Strategies that may help you communicate if you are experiencing slurred speech or voice changes include:

• Think loud and speak loud. You may feel you’re shouting but to others your speech will sound less slurred and at normal volume.
• Breath support. Ensure you take deep breaths before you speak.
• Pause between words to help with clarity.
• Exaggerate and over-articulate.
• Reduce any background noise or distractions where possible.

Your speech and language therapist will also be able to assess your swallow and make recommendations for the safest food/drink consistencies. They will advise on any exercises or strategies you can do to try and improve your swallow. If required, your speech and language therapist can request an x-ray of your swallow.

What is Multiple Sclerosis?

Multiple sclerosis (MS) is a neurological condition that results from damage to the central nervous system, or the brain and spinal cord. MS can cause a wide range of symptoms that vary in severity. There are different types of MS. Symptoms can be progressive, or involve ‘relapses’ with episodes of new or worsening symptoms, followed by a period ‘remission’ where symptoms improve. It is common for people with MS to have symptoms that affect their communication or swallowing, including:

• Slow or slurred speech
• Memory or concentration difficulties
• Difficulty with eating, drinking and swallowing

What is the role of the Speech and Language Therapist?

Speech and Language Therapists can help people with MS manage difficulties related to communication or swallowing. SLTs will work alongside you, your family, and the multidisciplinary care team to assess and manage your symptoms. People with MS can access SLT services in hospital or in the community.

SLTs can complete a speech assessment and work with you on strategies to improve your speech clarity and effectiveness. Your SLT can also work with you to manage any cognitive difficulties you may experience. Cognition includes memory, attention, concentration, and other ‘thinking’ skills. If you experience coughing or choking while eating or drinking, your speech and language therapist may carry out a swallowing assessment and advise ways to minimise or avoid problems.

What is Myasthenia Gravis?

Myasthenia gravis is a rare long-term condition that causes muscle weakness. It most commonly affects the muscles that control the eyes and eyelids, facial expressions, chewing, swallowing and speaking. However, it can affect most parts of the body. It can affect people of any age, typically starting in women under 40 and men over 60.

Treatment can usually help keep the symptoms under control. Very occasionally, myasthenia gravis gets better on its own. If severe, myasthenia gravis can be life-threatening but it does not have a significant impact on life expectancy for most people

What is the Role of the SLT?

Speech and Language Therapists can help patients with Myasthenia Gravis to manage their difficulties with swallowing and communication. This may be different for each person, depending on the impact and severity of the difficulty and each person’s overall management plan.

Patients with Myasthenia Gravis may have difficulties with their speech, including slurred speech, trouble controlling pitch, hypernasality  and sometimes having a more monotone sounding voice. Speech and Language Therapists can help with fatigue management (as fatigue can exacerbate symptoms), exploring ways to adapt the environment and/or different communication devices which may help you to be better understood. The impact of myasthenia gravis on swallowing may happen gradually or suddenly. A Speech and Language Therapist may want to assess how you mange eating and drinking different food and drink consistencies, to help advise what might be safest and easiest for you to swallow. A Speech and Language Therapist may also provide advice about reducing the impact of fatigue on your swallowing difficulty, including having meals little and often, resting before meal times and choosing foods that do not require a lot of chewing and effort.

What is a chronic cough?

Chronic cough is a persistent cough lasting eight weeks or more. Chronic cough has no identifiable cause in up to 20% of patients. Some of these patients will require therapy to help control their cough.

What is the role of the SLT?

Speech and language therapists contribute to assessment of chronic cough and provide non-medical treatment for controlling the cough. Therapy sessions include exploring techniques to put the cough under conscious control and reduce irritation in the throat. Therapy can occur in combination with drug treatments.
Patients with a chronic cough may be referred to Speech and Language Therapy after seeing a respiratory physician.

What is Muscle Tension Dysphonia?
Muscle Tension Dysphonia (MTD) is one of the most common voice disorders. It occurs when the muscles around the larynx (voice box) are tight during speaking that the voice box does not work efficiently.
The signs and symptoms of MTD are hoarse/rough/weak sounding voice, tightness in the throat, tender neck, sudden breaks or fading of the voice, loss of vocal range when singing or feeling you need to clear your throat. MTD can begin without warning and can be caused by reflux, irritants, smoking or excessive demand on your voice.

What is the role of the Speech and Language Therapist?

Speech and Language Therapy (SLT) play a key role in the treatment of MTD. We can provide voice therapy to decrease excessive tension so the vocal cords can function effectively again. Treatment may only require a few sessions or may take longer depending on how long the problem has been present and the individual’s response to treatment.
Voice therapy can involve working on your posture and improving your breathing pattern to support the voice. Relaxation techniques can reduce the general neck or shoulder tension that contribute to MTD. Finally, specific vocal exercises are provided to redistribute the working load to the appropriate vocal muscles.

What are Vocal Cord Nodules?
The vocal cords are two bands of muscle and vibratory tissues inside of your voice box. They come together and vibrate to produce sound when you speak, sing or use your voice in other ways.
A vocal cord nodule is a lump of tissue that grows on the vocal cord which means they cannot come together and close properly. It affects your voice and you may find it painful to produce voice, may have a hoarse sounding voice and have less range in their pitch and volume. A vocal cord nodule is usually caused by too much stress on the vocal cords such as misusing or overusing your voice. Speaking, singing, yelling or straining your voice can cause the vocal cords to become irritated and inflamed. The longer a nodule is left the worse it will become. People who use their voice for work such as teachers or a singers are more susceptible to vocal cord nodules.

What is the role of the Speech and Language Therapist?
Speech and Language Therapy treats the cause of vocal cord nodules. Voice therapy can help to reduce the stress on the vocal cords and establish a more efficient way of using the voice with less strain and tension. Education on how to take care of your voice, called vocal hygiene, is provided by the Speech and Language Therapist. This can prevent further damage or voice injuries in the future.