Voice disorders associated with hyperfunction 121

larynx height) are likely to be good indicators of hyperfunction (Morrison

and Rammage, 1994; Colton and Casper, 1996), so that perceptual rating
of the client’s voice is likely to be a valuable component of the evaluation
process. Carding, in Chapter 5 of this book, outlines current approaches
to the perceptual and observational assessment of voice.
Finally, assessment of vocal hyperfunction will, at the very least, require
careful documentation of the hyperfunctional behaviours listed earlier in
this chapter (e.g. yelling and screaming, speaking with hard glottal attack,
excessive coughing and throat clearing). Documentation of the nature,
frequency and severity of such behaviours is most effectively conducted
using the self-report of the client, reports of significant others such as
parents and teachers and direct observation of the client in the clinic and
in naturalistic speaking and/or singing environments. Observation of vocal
behaviours in naturalistic situations such as playgrounds, theatres, sports
fields and classrooms is particularly important as the client’s voice use in
the clinical environment will often be unrepresentative of their everyday
vocal patterns (Boone and McFarlane, 1994).

Management of voice disorders associated with

vocal hyperfunction
Successful management of voice disorders related to vocal hyperfunction
requires that clinicians address three major factors; the underlying causes
and contributing factors of hyperfunctional voicing, the specific hyperfunc-
tional behaviours themselves, and the client’s general hyperfunctional
vocal technique. The effects of underlying medical and psychological
factors as well as laryngeal irritants and faulty learning patterns need to be
minimized, specific hyperfunctional behaviours such as yelling and throat
clearing need to be reduced or eliminated, and the client needs to learn to
use vocal techniques which promote optimum levels of laryngeal muscle
tension and normal voice quality, pitch and loudness.

Minimization of the effects of the underlying causes of vocal

hyperfunction
For many clients with hyperfunctional voice problems, a symptomatic
approach which focuses only on changing vocal behaviours is likely to be
less effective than an approach which also addresses the causes of the
hyperfunctional patterns (Aronson, 1990; Stemple et al., 1995a; Colton
and Casper, 1996). Causal and contributing factors will vary depending
on the client, so that the diagnostic process of searching for individual
aetiological factors will be critical for the design of the management
programme.