Voice Disorders

Fourth Edition

Christine Sapienza, Bari Hoffman

Details: 517 pages, Full Color, Softcover, 7" x 10"

ISBN13: 978-1-63550-251-0

© 2022 | Available

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With this exciting new edition, the study of voice disorders comes out of its infancy and into the modern era of care for the voice!

With Voice Disorders, Fourth Edition, authors Christine Sapienza, PhD and Bari Hoffman, PhD have created a comprehensive package for learning. The authors uniquely blend voice science with voice treatments ranging from traditional interventions to recent advances in cellular therapies, muscle strength training, and treatments for special populations. The text has been extensively updated with clinical evidence-based information and comes with a robust online companion website including a study workbook, videos, audio files, and case studies.

This fourth edition offers a comprehensive combined study of the respiratory, laryngeal, and neurological subsystems for voice. Therapy approaches are categorized in terms of type, such as physiologic, combined modality, and hygienic. The new edition expands the approaches to voice therapy, and better defines clinical decision making with information about humanistic communication strategies, adherence, and the multitude of variables that influence patient outcomes.

New to the Fourth Edition:

  • The anatomical illustrations are now in color
  • Updated throughout to reflect the current state of research in the evaluation and treatment of voice and upper airway disorders
  • Many new references depicting evidence-based outcomes
  • Updated clinical guidelines and position statements
  • A thoroughly revised chapter on voice therapy
  • Extensive content added on gender affirmation: the role of the SLP along with various evaluation and therapy approaches
  • More laryngeal images and endoscopic examinations
  • Expanded coverage of contemporary phonosurgery approaches and the role of the SLP pre- and post-surgery
  • Extensively expanded material on head and neck cancer and alaryngeal communication

From the Foreword

"...This fourth edition of Voice Disorders builds on the earlier editions and offers the student and clinician a comprehensive combined study of the respiratory, laryngeal, and neurological subsystems that make up voice production. The authors blend voice science with voice treatments ranging from traditional interventions to recent advances in cellular therapies, muscle strength training, and treatments for special populations such as singers and actors and those with complex medical conditions. Cases highlight various intervention strategies. With this fourth edition of Voice Disorders, the study of voice disorders comes out of its infancy and into the modern era of comprehensive care for the voice. ...I have had to privilege of reviewing previous editions of Voice Disorders and share a rich professional and personal relationship with the authors. They both reflect the title “teacher-scientist-clinician” and this edition punctuates that title perfectly. Since they are both teachers, they understand the needs of students and have developed educational approaches to nourish those needs in the classroom as well as in the research lab and in clinical practice."

Thomas Murry, PhD
Professor, Otolaryngology-Head and Neck Surgery
Co-Director, Loma Linda University Voice and Swallowing Center
Loma Linda University Health Center

Foreword by Thomas Murry, PhD




Companion Website


Chapter 1. Respiratory Anatomy and Physiology 

The Lungs 

The Trachea 

The Bronchi 

The Thorax 

The Ribs 

The Diaphragm 

The Abdominal Wall 



Driving Forces of the Respiratory System 

How Does the Human Body Generate These Respiratory Forces? 

Passive and Active Forces of the Respiratory System 

The Respiratory System and Voice Production 

Relaxation Pressure Curve

Using the Right Terminology

Biofeedback Techniques




Chapter 2. Laryngeal Anatomy and Physiology

Laryngeal Anatomy

Laryngeal Structure: Pieces and Parts

Laryngeal Muscles

What Are the Vocal Folds Made of, Exactly?

Laryngeal Ligaments and Membranes

Extrinsic Membranes

Intrinsic Membranes


Aryepiglottic Folds


Arterial Supply of the Larynx

Laryngeal Nerve Supply

Laryngeal Development (Infancy to Adulthood)

Adult Male and Female Differences in Laryngeal Anatomy

Age Effects on Laryngeal Anatomy


Mechanisms for Changing Pitch

What Is a Vocal Register?

Mechanism for Changing Loudness




Chapter 3. Vocal Health


Basic Issues Related to Vocal Health

Recovery Process

Contributors to Poor Vocal Health




Chapter 4. Evaluation

The Specialty of Otolaryngology

Case History

The Physical Examination

Laryngoscopic Techniques

Instrumental Assessment


Digital Laryngostroboscopy



Classic Methods for Collection of Aerodynamic Signals

Laryngeal Aerodynamic Variations

Laryngeal Aerodynamics as a Function of Aging

Laryngeal Aerodynamic Differences as a Function of Sex

Laryngeal Aerodynamic Changes as a Function of Speech Task

Using Aerodynamics for Examination of Voice Disorders

Acoustic Analysis of Voice


Voice Range Profile

Short-Term Perturbation

Relative Noise Level

Spectral Measures

Fast Fourier Transform (FFT)

Vowel Spectrum

Long-Term Average Spectrum

Cepstral Peak



Auditory-Based Measures of Voice Quality

Indices Obtained by Combining Measurements

Perceptual Rating Scales

Voice Handicap Scales and Quality-of-Life Scales

Voice Handicap Index

Voice-Related Quality-of-Life Scale

Hygiene and Safety of Equipment



Appendix 4–1. Case History Form — Voice

Appendix 4–2. Videostroboscopy Rating Form

Appendix 4–3. Position Statement: Evidence-Based Practice in Communication Disorders

Appendix 4–4. Relevant Paper: The Roles of Otolaryngologists and Speech-Language Pathologists in the Performance and Interpretation of Strobovideolaryngoscopy

Appendix 4–5. Voice Handicap Index

Appendix 4–6. Voice-Related Quality of Life Measure

Appendix 4–7. Recommended Protocols


Chapter 5. Vocal Pathology

Etiology of Voice Disorders

Vocal Lesions

Pathology Classifications

Incidence of Voice Disorders

Structural Pathologies of the Vocal Folds

Vascular Lesions

Functional Voice Disorders






Chapter 6. Neurologically Based Voice Disorders

Neurologic Voice Disorders

Other Neurologic Cases




Chapter 7. Vocal Rehabilitation

Addressing Patient Diversity in Vocal Rehabilitation

Clinical Competence

The Road to Therapy

Communication Strategies


Voice Therapy

The Evolving Process of Voice Therapy

Goals of Voice Therapy

Definition of Treatment Efficacy

Voice Therapy Approaches: What Are They?

Specific Treatments for Other Populations

Special Considerations for Gender-Affirming Voice and Communication Therapy

Voice Therapy for School-Age Children With Voice Disorders

Technology and Gaming in Voice Therapy

Biofeedback Techniques

Alternative Voice Management

Defining a Voice Outcome

Criteria for Termination of Therapy

Telehealth Options

Definition of Treatment Effectiveness



Appendix 7–1. Voice Stimuli


Chapter 8. Management: Phonosurgery

Surgical Treatment of Dysphonia

Awake Procedures

General Considerations in the Surgical Approach to the Larynx

Microlaryngoscopy With Nodule Removal

Microflap Dissection

Laser Laryngoscopy

Laryngeal Microdebrider Dissection

Injection Augmentation

Laryngeal Framework Surgery

Selected Clinical Cases

Suggested References for Reading

Appendix 8–1. Postoperative Instructions for Surgery of Vocal Fold Lesions


Chapter 9. Team Management of Head and Neck Cancer


Head and Neck Cancer Statistics

Head and Neck Cancer Sites

Head and Neck Cancer Types

Head and Neck Squamous Cell Cancers

General Cancer Staging

Primary Tumor Staging

Cancer Spread

Surgical Options for Treating Head and Neck Cancer

Organ Preservation Through Radiation and Chemotherapy

Combined Management Approaches

Multidisciplinary Clinical and Research Team

Surgical Options for Laryngeal Cancer

The Role of the Speech-Language Pathologist Prior to Laryngectomy

The Role of the Speech-Language Pathologist Following Laryngectomy

Types of Partial Laryngectomy Procedures

Postoperative Strategies

Communication Following Total Laryngectomy

Developing a System to Track Outcomes With the HNC Population

Future Directions


Useful Websites


Appendix 9–1. Case Example: Management of SCCA In Situ in a Professional Performer: An Interdisciplinary Approach

Appendix 9–2. Case Example: Management of Recurrent Laryngeal Cancer Spanning 10 Years

Appendix 9–3. Voicing Practice Exercises: Handout for the Laryngectomized Patient 


Chapter 10. Vocal Performance

What Constitutes Singing Voice Intervention?

The Singing Voice

The Voice Care Team

Performer Classifications and Vocal Registers

Etiology of Dysphonia in Vocal Performers

Compensatory and Cover Techniques Used by Vocal Performers

Singers and Support

Clinical Assessment of Vocal Performers

The Medical, Social, and Singing History

Speaking Voice Assessment

Vocal Load

Vocal Pacing and Budgeting

Singing Voice Assessment

Training and Techniques Specific to Performance Voice

Case Examples

Singing Health

Professional Associations

Case Studies



Appendix 10–1. Singer’s History Form

Appendix 10–2. Singing Voice Handicap Index (S-VHI)

Appendix 10–3. Evaluation of the Ability to Sing Easily (EASE)

Appendix 10–4. Glossary of Singing Terms


Chapter 11. Drug Types and Effects on Voice

Drug Interactions

Patient-Specific Factors

Drug Administration

Drug Classes

Psychoactive Medications

Drug Compliance

Herbal Supplements and Alternative Medicines

Special Populations


Recommended Readings


Appendix 11–1. Chapter 11 Glossary


Chapter 12. Immune System Response to Diseases and Its Impact on Laryngeal Function


Innate Immunity and Wound Healing

Adaptive Immunity

Fibroblasts’ Immune Functions

Immunologic Barriers to Treatment


Cell-Based Therapies




Chapter 13. Laryngeal Reflexes

Sensory Receptors

Free Nerve-Ending Receptors

Encapsulated Nerve Endings

Pathway of Sensory Information

Laryngeal Reflexes

Upregulation of Sensory Afferents

Down Regulation of Sensory Afferents





Christine Sapienza

Christine Sapienza, PhD, CCC-SLP, serves as Provost of Jacksonville University. Previously, Dr. Sapienza was a longstanding tenured professor and chair of the Department of Communication Sciences and Disorders at the University of Florida, as well as a research career scientist at the Brain Rehabilitation Research Center at the Malcom Randall Veterans Administration Hospital. As a principal investigator of National Institutes of Health grants, VA Research Rehabilitation Research and Development Awards, and a M.J. Fox Foundation grant, Dr. Sapienza has provided extensive mentoring to 16 doctoral students, all of whom have contributed back to academics and clinical service. She has built a strong national and international reputation for expertise in the design and implementation of larger scale randomized clinical trials examining treatments as well as the careful reporting of peer-reviewed outcomes from these studies. Dr. Sapienza methodically disseminates this information to the scientific community at large in the form of invited presentations, workshops, and clinical teaching platforms. Through writing, she works to integrate research findings in journal articles, textbooks, and clinical manuals. As a frequent contributor to patient support groups she aspires to assist patients and caregivers as they navigate available treatments and emerging science. 

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Bari Hoffman

Bari Hoffman, PhD, CCC-SLP, is an Associate Dean in the College of Health Professions and Sciences, Professor in the Department of Communication Sciences and Disorders, with a joint appointment in Internal Medicine within the College of Medicine at the University of Central Florida. Dr. Hoffman serves as Director of the Center for Voice Care and Swallowing Disorders at the Ear Nose Throat and Plastic Surgery Associates. She has worked clinically in this setting for more than 20 years treating individuals with voice and upper airway disorders specializing in pediatric, professional, and neurogenic populations, along with individuals undergoing treatment for head and neck cancer. Dr. Hoffman received her doctoral degree from the University of Florida in 2001. Her current research involves studying novel treatment technologies and biomechanical mechanisms for disorders of laryngeal function, while defining the high impact on quality of life factors. She implements 3-D computer modeling of upper and lower airway function, coping strategies of individuals with dysphonia, and respiratory muscle strength paradigms in a variety of patient groups. Dr. Hoffman has a significant record of peer-reviewed publications, authorship of two other textbooks: Cases in head and Neck Cancer: A Multidisciplinary Approach and Respiratory Muscle Training. She actively lectures across the country and internationally on these topics. In recognition of her contributions to teaching, research, and service, she has received numerous awards within her university, state, and national associations.

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Voice Disorders, The Fourth Edition comes with access to supplementary student and instructor materials on a PluralPlus companion website.


To access the student materials, you must register on the companion website and log in using the access code printed on the inside front cover of your book.



To access the instructor materials, you must contact Plural Publishing, Inc. to be verified as an instructor and receive your access code.

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            Tel: 866-758-7251 (toll free) or 858-492-1555

*Note for students: If you have purchased this textbook used or have rented it, your access code will not work if it was already redeemed by the original buyer of the book. Plural Publishing does not offer replacement access codes for used or rented textbooks.

Clinical Voice Pathology: Theory and Management

Sixth Edition

Joseph C. Stemple, Nelson Roy, Bernice K. Klaben

Details: 540 pages, Full Color, Softcover, 7" x 10"

ISBN13: 978-1-63550-028-8

© 2020 | Available

Voice Therapy: Clinical Case Studies

Fifth Edition

Joseph C. Stemple, Edie R. Hapner

Details: 508 pages, B&W, Softcover, 7" x 10"

ISBN13: 978-1-63550-035-6

© 2019 | Available

Cases in Head and Neck Cancer: A Multidisciplinary Approach

First Edition

Bari Hoffman, Henry Ho, Christine Sapienza, Jeffrey J. Lehman

Details: 304 pages, Full Color, Hardcover, 8.5" x 11"

ISBN13: 978-1-59756-715-2

© 2016 | Available

Visual Examination of Voice Disorders

First Edition

Christine Sapienza, Bari Hoffman

Details: DVD

ISBN13: 978-1-59756-514-1

© 2013 | Available

Respiratory Muscle Strength Training: Theory and Practice

First Edition

Christine Sapienza

Details: 87 pages, B&W, eBook

ISBN13: 978-1-59756-626-1

© 2012 | Available

Treatment Resource Manual for Speech-Language Pathology.

Sixth Edition

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Details: 539 pages, 2-Color, Softcover (with lay-flat binding), 8.5" x 11"

ISBN13: 978-1-63550-118-6

© 2021 | Available

Exercises for Voice Therapy

Third Edition

Alison Behrman, John Haskell

Details: 289 pages, B&W, Softcover, 8.5" x 11"

ISBN13: 978-1-63550-183-4

© 2020 | Available

Respiratory Muscle Strength Training

First Edition

Christine Sapienza, Bari Hoffman

Details: 279 pages, B&W, Softcover, 6" x 9"

ISBN13: 978-1-63550-257-2

© 2021 | Available

Speech and Voice Science

Fourth Edition

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Details: 517 pages, 2-Color, Softcover, 8.5" x 11"

ISBN13: 978-1-63550-322-7

© 2023 | Available

Medical Speech-Language Pathology Across the Care Continuum: An Introduction

First Edition

Alex F. Johnson, Barbara H. Jacobson, Megan E. Schliep, Bridget J. Perry

Details: 378 pages, Full Color, Softcover, 7" x 10"

ISBN13: 978-1-63550-268-8

© 2024 | Available