In Japan, voice therapy by speech therapist (STs) is rarely provided for professional singers with dysphonia. However, I believe that voice therapy by STs should be provided for professional singers who complain of singing voice problems that affect their work performance, even though their vocal cord lesions are minute. The purpose of this paper is to review the literature on the efficacy of voice therapy for professional singers with dysphonia and to provide some key pointers for undertaking voice therapy in practice.
The most important points of vocal hygiene advised to professional singers are: 1) avoid abuse and misuse of the voice other than singing, 2) keep the vocal cords moist, and 3) undertake vocal warm-up/cool-down. The following points should be kept in mind regarding vocal training: 1) intensive training should be provided whenever the patient is able to come to the clinic, 2) trial voice therapy should be provided and the most appropriate technique should be used, and 3) instruction in singing techniques (how to sing well) should be provided by a singing coach. The use of semi-occluded vocal tract exercises for vocal training has been reported to reduce damage from vocal cord contact and improve vocal function in singers.

Orthognathic surgery for cases of skeletal prognathism aim at esthetic enhancement of the profile by changing the maxillo-mandibular relationship, but few clinical observations of the surgery's influence on masticatory and articulatory functions have been performed. Using electropalatography (EPG), we observed tongue-palate contact patterns before and after surgery. The subjects were two 22-year-old males with skeletal class 3 malocclusion who underwent the identical operation to retract the mandible distally (sagittal split of mandibular ramus osteotomy). The speech samples used were [asa] and [ata], including alveolar consonants. Before the operation, EPG of /s/ and /t/ showed a fronting pattern in both cases, but this changed to a typical pattern within two months after the operation. These contact patterns were stable at 1 year postoperatively. Center of gravity (COG) value was calculated before and after the operation. This value indicates the concentration of electrode contacts along the anterior-posterior axis of the palate. The more anterior the contact, the higher the COG value. Except for /t/ in Case 1, the COG values increased after the operation. Observation using EPG suggested that tongue-palate contact patterns during speech might be influenced by changes in the skeletal relationship and anterior occlusion after orthognathic surgery.

We investigated the effect of voice therapy on age-related vocal fold atrophy. The subjects were 21 patients with vocal fold atrophy aged 55-80 years (average: 69.7 years), consisting of 14 men and 7 women. All patients were treated with voice therapy (vocal function exercises, etc.). After voice therapy, significant improvements were observed in both the overall and individual elements of the GRBAS scale, maximum phonation time, jitter value, and VHI-10 score. In addition, we examined the correlation between improvement in VHI-10 score and individual factors such as age and gender. Correlation analysis showed no significant correlation between VHI-10 score and any of the individual factors. Furthermore, we performed logistic regression analysis to predict voice improvement from individual factors. Regression analysis revealed that a smaller glottal gap slit is a predictor of better VHI-10 improvement after voice therapy. The present study suggested that the pre-therapeutic glottal gap slit is a possible tool for foreseeing voice therapy's outcome.

Differential diagnosis is important when treating spasmodic dysphonia (SD). We report on cases presenting with adductor SD or functional dysphonia (FD) in the ten years from 2007 to 2017. Of a total of 826 cases, 106 were treated with both botulinum injection and voice therapy, in one of four patterns: (1) injection first, accompanied by supplementary therapy (diagnosis of SD): 27 cases; (2) injection first, followed by shift to therapy (diagnosis of FD): 33 cases; (3) therapy first, followed by shift to injection (diagnosis of SD): 32 cases; (4) therapy first, followed by injection, followed by resumption of therapy (diagnosis of FD): 14 cases. With both injection and therapy, treatment proved effective or was useful for conducting differential diagnosis. For this reason, we believe having two choices - injection and/or therapy - is significant for deciding on courses of treatment.