Plural Publishing produces leading academic, scientific and clinical publications in the fields of speech-language pathology, audiology, and otolaryngology.


Voice Therapy
Clinical Case Studies

Fourth Edition
Joseph C. Stemple, Edie R. Hapner
560 pages, Illustrated (B/W), Softcover, 7 x 10"
Release Date:
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Voice Therapy: Clinical Case Studies, now in its fourth edition, has been extensively revised and updated and is replete with new clinical case examples of voice therapy techniques from master clinicians in the field. Through concise patient histories, pre- and post-treatment evaluations, and tailored therapeutic approaches, this classic text addresses assessment, management, as well as treatment and therapy approaches for a range of voice disorders; muscle tension dysphonia, glottal incompetence and neurogenic disorders, and professional voice care. This new edition is the ideal text for both students learning the basics of voice disorders and practicing clinicians providing voice care.


  • Moira E. Little, The British Voice Association - Communicating Voice (Spring 2015):
    "Since the first edition of this book, the purpose of the text remains the same: “to provide both the student and the working clinician with a broad sampling of management strategies as presented by master voice clinicians”. Over 70 voice specialists have contributed cases to this book, mostly American, apart from the BVA’s own Sara Harris, who describes using the Accent Method with a patient.... The joy of this book is having the privilege of voice specialists sharing details of their clinical work, including very specific information on frequency, duration and content of therapy, with exact instructions given by the therapist. I would highly recommend this book for all clinicians working in voice, from student to advanced practitioner, as it demonstrates very clearly both the science and the art of voice therapy in a very practical way."


1 Principles of Voice Therapy
2 Comments on Voice Evaluation
Joseph C. Stemple

3 Primary and Secondary Muscle Tension Dysphonia
Introduction: Muscle Tension Dysphonia: An Overview
Nelson Roy

Case Study 1. Behavioral Shaping in Primary MTD Masquerading
as Elective Mutism in a 10-Year-Old Boy
R. E. Stone Jr and Kimberly Coker

Case Study 2. Management of Primary MTD in a 13-Year-Old Using
Falsetto Voice to Modify Phonation
Joseph C. Stemple

Case Study 3. Use of Laryngeal Massage and Resonant Therapy in
Primary MTD in an Adolescent
Susan Baker Brehm

Case Study 4. Flow Phonation in a Teenager with Primary Muscle
Tension Aphonia
Jackie Gartner-Schmidt

Case Study 5. Manual Circumlaryngeal Techniques in the Assessment
and Treatment of Primary MTD in a 55-Year-Old Woman
Nelson Roy

Case Study 6. Management of Primary MTD Initially Masquerading
as a Paralytic Dysphonia in a 39-Year-Old Woman Using an Enabling
Claudio Milstein

Case Study 7. Use of Patient-Family Education and Behavior
Modification to Treat MTD Secondary to Vocal Nodules
Leslie Glaze

Case Study 8. Eclectic Voice Therapy for Secondary MTD in a
10-Year-Old With a Vocal Fold Cyst
Carissa Portone-Maira

Case Study 9. Using a Psychosocial Management Approach in the
Therapy of a Child With Midmembranous Lesions and Secondary MTD
Moya Andrews

Case Study 10. Treatment of Secondary MTD in a Child With Early
Bilateral Lesions: A Telehealth Approach
Lisa N. Kelchner

Case Study 11. Treating a Child With MTD Secondary to Vocal Nodules
Using Concepts From Adventures in Voice
Rita Hersan

Case Study 12. Pediatric Vocal Fold Nodules and Secondary MTD
Treated in Conjunction With a School-Based SLP
Rebecca Hancock

Case Study 13. Use of Vocal Function Exercises in the Treatment of an
Adult With Secondary MTD
Joseph C. Stemple

Case Study 14. Accent Method in the Treatment of Secondary MTD
Sara Harris

Case Study 15. Voice Therapy Boot Camp in the Treatment of
Secondary MTD in an Adult
Rita Patel

Case Study 16. Medical and Therapeutic Management of
Laryngopharyngeal Reflux With Resulting Secondary MTD
Sandra A. Schwartz

Case Study 17. Management of Secondary MTD Associated With
Vocal Process Granulomas
Heather Starmer

Case Study 18. Lessac-Madsen Resonant Voice Therapy in the
Treatment of Secondary MTD
Diana M. Orbelo, Nicole Yee-Key Li, and Katherine Verdolini Abbott

Case Study 19. Use of Ambulatory Biofeedback to Supplement
Traditional Voice Therapy for Treating Primary MTD in an
Adult Female
Tara Stadelman-Cohen, Jarrad Van Stan, and Robert E. Hillman

Case Study 20. Use of Glottal Attack in the Treatment of Primary MTD
in an Adult Female Presenting With Persistent Falsetto
Joseph C. Stemple

Case Study 21. The Use of a Multi-Approach Therapy in a Female
Professional Voice Speaker Presenting With a Primary MTD Marked
With Habitual Falsetto Phonation
Mara Behlau and Glaucya Madazio

Case Study 22. Use of Hard Glottal Attack as Laryngeal Manipulation
to Modify Mutational Voice in a 16-Year-Old Male
Lisa Fry

4 Management of Glottal Incompetence 189
Introduction 189
Case Study 1. Treatment Strategies Used for Unilateral Vocal Fold
Paralysis in a Case With a Complex Medical History
Stephen C. McFarlane and Shelley Von Berg

Case Study 2. Use of Physiologic Therapy Approaches to Treat
Unilateral Vocal Fold Paralysis Following Complications From a
Total Thyroidectomy
Mara Behlau, Gisele Oliveria, and Osíris do Brasil

Case Study 3. Treatment of Glottal Incompetence With Secondary
Muscle Tension Dysphonia in a Patient With Unilateral Vocal Fold
Maria Dietrich

Case Study 4. Use of Semi-Occluded Vocal Tract Methods and
Resonant Voice Therapy to Treat Unilateral Vocal Fold Paralysis
Julie Barkmeier-Kraemer

Case Study 5. Use of Expiratory Muscle Strength Training in a Case of
Unilateral Vocal Fold Paralysis 4 Years Post Chemotherapy/Radiation
Bari Hoffman Ruddy, Christine M. Sapienza, Erin Silverman, and Henry Ho

Case Study 6. Brief Discussion and Case Presentation of Treatment for
Superior Laryngeal Nerve Paralysis Using Medical, Surgical, and
Behavioral Interventions
Bruce J. Poburka

Case Study 7. Use of Phonation Resistance Training Exercises (PhoRTE)
in a Part-Time Cooking Instructor With Presbyphonia
Aaron Ziegler and Edie R. Hapner

Case Study 8. Use of Vocal Function Exercises in an Elderly Man With
Stephen Gorman

Case Study 9. Treatment of Glottal Incompetence Caused by Sulcus
Vocalis: Evidence of a Team Approach for Vocal Rehabilitation
Amanda I. Gillespie and Clark A. Rosen

Case Study 10. Improvement of Vocal Fold Closure in a Patient With
Voice Fatigue
Joseph C. Stemple

Case Study 11. An Eclectic Approach in the Management of an
Individual With Vocal Fatigue
Chaya Nanjundeswaran


5 Dystonia, Essential Tremor, and Other Neurogenic Disorders

Case Study 1. Functional Voice Therapy for Spasmodic Dysphonia
Joseph C. Stemple

Case Study 2. Medical and Behavioral Management of Adductor
Spasmodic Dysphonia
Edie R. Hapner and Michael M. Johns

Case Study 3. Combined Laryngeal Injection of Botulinum Toxin and
Voice Therapy for Treatment of Adductor Spasmodic Dysphonia
Eileen M. Finnegan

Case Study 4. Use of Reduced Voicing Duration to Treat Vocal Tremor
Julie Barkmeier-Kraemer

Case Study 5. Use of LSVT® LOUD (Lee Silverman Voice Treatment)
in the Care of a Patient With Parkinson Disease
Lorraine Ramig and Cynthia Fox

Case Study 6. Use of Telehealth Technology to Provide Voice Therapy
Lyn Tindall Covert

6 Irritable Larynx Syndrome, Paradoxical Vocal Fold
Dysfunction, and Chronic Cough

Introduction to Irritable Larynx Syndrome
Linda Rammage

Case Study 1. A Case of ILS Managed by a Comprehensive Approach
to Multiple Central Sensitivity Syndrome Triggers
Linda Rammage

Case Study 2. Multimodality Behavioral Treatment of Long-Standing
Chronic Cough in an Adult
Marc Haxer

Case Study 3. Failed Voice Therapy With Successful Use of Central
Nervous System Inhibitors in Chronic Cough
Madeleine Pethan and Laureano Giraldez-Rodriguez

Paradoxical Vocal Fold Motion: An Introduction
Mary J. Sandage

Case Study 4. Treatment of PVCD in a Collegiate Swimmer
Mary J. Sandage

Case Study 5. Management of PVCD: An Adolescent Athlete With
Exercise-Induced Dyspnea
Michael D. Trudeau, Jennifer Thompson, and Christin Ray

Case Study 6. Treatment of Paradoxical Vocal Fold Motion Disorder in a 9-Year-Old Athlete
Maia Braden

Case Study 7. Paradoxical Vocal Fold Movement (PVFM): A Case of
the Young Athlete With Associated Psychosocial Contributions
Mary V. Andrianopoulos

7 Management of the Professional, Avocational, and
Occupational Voice

Marina Gilman

Case Study 1. Management of Vocal Fold Nodules in a Female
Prepubescent Singer
Patricia Doyle and Starr Cookman

Case Study 2. The Developing Performer
Barbara Jacobson

Case Study 3. 19-Year-Old Talented Male Singer, Presenting With
Soft Bilateral Vocal Fold Lesions
Marina Gilman

Case Study 4. Therapeutic Modalities for the Touring Musical Theater
Vocal Athlete
Wendy D. LeBorgne

Case Study 5. Voice Intervention for a Touring Broadway Singer
Shirley Gherson

Case Study 6. The High-Risk Vocal Performer
Bari Hoffman Ruddy, Jeffrey Lehman, and Christine M. Sapienza

Case Study 7. Semi-Occluded Vocal Tract Exercises and Resonant
Voice Therapy in the Perioperative Management of a Professional
Actor and Singer With a Vocal Fold Cyst
Sarah L. Schneider and Mark S. Courey

Case Study 8. Treating Vocal Injury in a Physically and Vocally
Demanding Performer
Wendy D. LeBorgne

Case Study 9. Voice Recalibration With the Cup Bubble Technique for
a Country Singer
Jennifer C. Muckala and Brienne Ruel

Case Study 10. Praise and Worship Leader Preremoval and
Postremoval of Bilateral Vocal Fold Lesions
Marina Gilman

Case Study 11. Use of Voice Therapy in Conjunction With Minimal
Injection Medialization in the Longitudinal Treatment of Dysphonia
in an Elite Operatic Singer
Brian E. Petty and Miriam van Mersbergen

Case Study 12. Voice Therapy in a 28-Year-Old Theater Actor
Kate DeVore

Case Study 13. Conversational Voice Therapy: A Case Describing
Application of Public Speaking Techniques to Voice Disorders
Alison Behrman


8 Successful Voice Therapy 479

Case Study 1. The Role of Self-Efficacy on Voice Therapy Adherence
Amanda I. Gillespie

Case Study 2. Using iPod Apps to Improve Voice Therapy Adherence
Between Sessions: A Social-Cognitive Approach
Eva van Leer

Case Study 3. There’s an App for That: Use of Portable Electronic
Software Applications to Facilitate Home Practice of Voice Exercises in
a Lawyer With Vocal Fold Nodules
Bryn Olson and Carissa Portone-Maira

Case Study 4. Threat of Being Fired From Therapy Improved a Vocal
Overdoer’s Adherence
Carissa Portone-Maira


Appendix 8–A. Selected Applications Useful in Voice Therapy


About The Authors

Joseph C. Stemple

Joseph C. Stemple, PhD, CCC-SLP, ASHAF, is professor of Communication Sciences and Disorders, College of Health Sciences, University of Kentucky where he specializes in the study of voice production and disorders. Current research interests include the biology of laryngeal muscles during exercise; the aging voice; and identifying the active ingredients of evidence-based voice therapy programs. Dr. Stemple is an active national and international speaker and lecturer. He is a Fellow and Honors recipient of the American Speech-Language-Hearing Association.

Edie R. Hapner

Edie R. Hapner, PhD, CCC-SLP, is a Professor in the Caruso Department of Otolaryngology Head and Neck Surgery and Director of Speech Language Pathology at the University of Southern California, Los Angeles, CA. She is a fellow of the American Speech Language and Hearing Association, and Associate Fellow of the American Laryngological Association and a Distinguished Fellow of the National Academy of Practice. She has presented hundreds of lectures, workshops, and seminars on voice and voice disorders. She has over 50 published articles in the area of voice and voice disorders, multiple book chapters, and is co-editor of the book Voice Therapy, Clinical Case Studies, Fourth Edition. Dr. Hapner developed and implemented the voice curriculum for Medbridge Inc, an online learning systems for speech language pathologists where multiple leaders in voice present accessible and easily understandable lectures on voice and voice disorders.

Dr. Hapner has served on the Board of Directors for the American Speech Language and Hearing Association as the Vice President of Planning, Coordinator of the SIG 3 Voice and Voice Disorders, member of the Voice Committee for the American Academy of Otolaryngology and served on the AAOHNS Guidelines Committee for Dysphonia. She will chair the ASHA Annual Convention in 2020.

Dr. Hapner's research interests include aging voice, dystonia and adherence to voice therapy. She is co-author of Phonation Resistance Training Exercises (PhoRTE), an evidence based treatment for aging voice.

Related Titles

Exercises for Voice Therapy

Exercises for Voice Therapy

Edited by: Alison Behrman, John Haskell

240 pages, Illustrated (B/W), Softcover, 8.5 x 11"