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ofthis CPB. ff-resonant voice therapy exercises pdf

Number: 0646
*Please see amendment for Pennsylvania Medicaid at the end Last Review 07/13/2017
ofthis CPB. Effective: 09/17/2002
Next Review: 07/12/2018
Note: Voice therapy is subject to any benefit limitations and
exclusions applicable to speech therapy. See CPB 0243 - Speech Review History
I. Aetna considers voice therapy medically necessary to restore
the ability of the member to produce speech sounds from the
larynx for any of the following indications:
A. Following surgery or traumatic injury to the vocal cords; or
B. Following treatment for laryngeal (glottic) carcinoma; or
C. Paradoxical vocal cord motion; or
D. Spastic (spasmodic) dysphonia; or
E. Vocal cord nodules; or
F. Vocal cord paralysis. Clinical Policy Bulletin Notes
II. Aetna considers voice therapy not medically necessary for any
of the following indications:
A. Essential voice tremor; or
B. Improvement of voice quality; or
C. Laryngeal hyperadduction; or
D. Laryngitis; or
E. Muscle tension dysphonia (functional dysphonia); or
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F. Occupational or recreational purposes (e.g., public
speaking, singing, etc.); or
G. Supraglottic vocal hyperfunction.
III. Aetna considers resonant voice therapy (e.g., Lessac-Madsen
resonant voice therapy, and Lessac Y-Buzz) experimental and
investigational because its effectiveness has not been
Note: Megaphones or amplifiers (e.g., ChatterVox, Mega Mite
Megaphone) may be of use in the absence of illness or injury and
therefore do not meet Aetna's definition of covered durable
medical equipment.
Note: An electronic artificial larynx (artificial voice box) that is
used by laryngectomized individuals and persons with a
permanently inoperative larynx is covered as a prosthetic. See
"Note" regarding electronic speech aids accompanying CPB 0437
- Speech Generating Devices. See also CPB 0560 - Voice
Prosthesis for Voice Rehabilitation Following Total
Note: Voice therapy for male-to-female transgender individuals to
feminize the voice or for female-to-male transgender individuals
to masculinize the voice is considered cosmetic. See also CPB
0615 - Gender Reassignment Surgery.
Vocal cord paralysis is a voice disorder that occurs when one or
both of the vocal cords (or vocal folds) do not open or close
properly (NIDCD, 1999). Vocal cord paralysis is a common
disorder, and symptoms can range from mild to life threatening.
Someone who has vocal cord paralysis often has difficulty
swallowing and coughing because food or liquids slip into the
trachea and lungs. This happens because the paralyzed cord or
cords remain open, leaving the airway passage and the lungs
Vocal cord paralysis may be caused by head trauma, a
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neurological insult such as a stroke, a neck injury, lung or thyroid
cancer, a tumor pressing on a nerve, or a viral infection (NIDCD,
1999). In older people, vocal cord paralysis is a common problem
affecting voice production. People with certain neurological
conditions, such as multiple sclerosis or Parkinson's disease, or
people who have had a stroke may experience vocal cord
paralysis. In many cases, however, the cause is unknown.
People who have vocal cord paralysis experience abnormal voice
changes, changes in voice quality, and discomfort from vocal
straining (NIDCD, 1999). For example, if only 1 vocal cord is
damaged, the voice is usually hoarse or breathy. Changes in voice
quality, such as loss of volume or pitch, may also be noticeable.
Damage to both vocal cords, although rare, usually causes people
to have difficulty breathing because the air passage to the trachea
is blocked.
Vocal cord paralysis is usually diagnosed by an otolaryngologist
(NIDCD, 1999). Noting the symptoms the patient has
experienced, the otolaryngologist will ask how and when the
voice problems started in order to help determine their cause.
Next, the otolaryngologist listens carefully to the patient's voice
to identify breathiness or harshness. Then, using an endoscope,
the otolaryngologist looks directly into the throat at the vocal
cords. A speech-language pathologist may also use an acoustic
spectrograph, an instrument that measures voice frequency and
clarity, to study the patient's voice and document its strengths
and weaknesses.
There are several methods for treating vocal cord paralysis,
among them surgery and voice therapy. In some cases, the voice
returns without treatment during the first year after damage
(NIDCD, 1999). For that reason, doctors often delay corrective
surgery for at least 1 year to be sure the voice does not recover
spontaneously. During this time, the suggested treatment is
usually voice therapy, which may involve exercises to strengthen
the vocal cords or improve breath control during speech.
Sometimes, a speech-language pathologist must teach patients
to talk in different ways. For instance, the therapist might suggest
that the patient speak more slowly or consciously open the
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Which exercises strengthen vocal cords? Which Exercises Strengthen Vocal Cords? Pressure Vibration Resonance Articulation