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“…One by one they speak in the presence of many and I listen by observing the expression of the face, the tone of the voice more or less high or low, the posture. At the sound of the voice, images are born in my mind..” Massimo Fagioli

We are talking about Voice right in the month of April because exactly on the day of April 16 every year, since 1999, we celebrate the World Voice Day. Initiative born in Brazil, which involved language scholars, doctors, singing teachers. This is therefore a moment aimed at promoting and caring for the voice. Let’s try to delve into this wonderful world called VOCE and we will do it with Giuliana Pisanu, Speech therapist expert in Clinical Vocology and President of the Italian Group of Clinical Vocologists, a group that includes speech therapists, otolaryngologists and speech therapists united by the same passion for studying. and the deepening in the vocal field.

Doctor Pisanu, what is the voice? The voice is the simplest and cheapest way to communicate, it is the tool that gives sound and shape to our thoughts, to our language. It is the most primitive form of communication that conveys our interiority as it indicates “how I am” (in a physical sense) and “how I feel” (in an emotional sense). It is one of the main elements that defines my identity, it defines “who I am” both in absolute terms in reference to physical characteristics (for example male, female, elderly, child) and in relative terms with respect to the role I assume at a given moment (for example wife, mother, lover, director, teacher, etc. ..) since it is connected to the need to be in the world and “acoustically” testify that we exist, it identifies us as unique and makes us bearers of our own meaning. It is therefore important to take care of it every day so that the voice with which we present ourselves is as much as possible echo of our feelings, without being altered by emotional, physical, stress or fatigue factors.

How does the speech therapist deal with the voice? The speech therapist expert in voice takes care of the person with a 360 ° care. I firmly believe that this is the basis of taking charge of any type of disorder, but in the vocal field the discomfort that the person expresses is amplified, since the voice is the means that conveys our interiority, our thoughts, our emotions in short. “What I feel” and “how I feel”. It can be considered my business card because through my voice I say a lot about myself, in a variable and unstable way or not always in the same way. This confirms that the “voice is not something we have but something we produce” and is always produced in a different way. It varies according to the state of tension I am in, the tiredness I feel, the interlocutor I am addressing, the content I am expressing, etc. The first meeting consists of the evaluation, the voice is a multidimensional phenomenon and as such we must analyze it, so we will conduct an investigation on what the patient’s lifestyle is, trying to relate any personality and the use he makes of the voice, we will carry out a clinical observation of vocal behavior, a perceptual and electroacoustic analysis and finally we will investigate through self-assessment questionnaires what is the impact that this discomfort has on the quality of life of the individual. The collection of such data allows to outline a rehabilitation / rehabilitation path that will accompany the patient to regain a euphonic voice, that is an emission that is not always perfect, but the production of the best possible voice emitted in a natural way and with minimal effort. possible, in the presence of certain anatomical-physiological conditions.

In which environments does your intervention develop? There are many areas of intervention: prevention and education within schools, such as athletics to make it effective and efficient in the face of particular professional requests (e.g. singers, actors …) in the absence of pathology, in the rehabilitation and remedial field in the presence of pathology.In developmental, adult and senile age because the voice changes with age, the body in fact ages over the years and this also happens to the larynx. The most evident variations are recorded in particular during childhood, when the voice is produced by structures of decidedly reduced dimensions compared to those of the adult, for this fragility of the organ must therefore be respected and protected in this particular age group. adapting requests. Another delicate moment since it is defined as a transition is adolescence in which we witness the so-called vocal change. Finally, with aging, there is an involution of function (presbyphonia), even here a series of structural and functional changes can lead to a real identity crisis.

According to your experience, what is the relationship between voice and emotions (also considering the problem in the absence of organic damage)? It is very close: the voice expresses our emotions directly without veils, unlike the word that expresses our thoughts. It is an affective indicator and reveals the mood changes present in the here and now. You can lie with the word, but not with the voice and its nuances: the modulation, the tone, the pauses, the silences, the speed, (A. Cimmino, R. Sperandeo, Counseling in speech therapy).

I quote: “Sometimes I listen to voices without being distracted by the words they contain. In those moments it is the souls that I feel. Each has its own vibration. “(Christian Bobin).

After this interview I have many other ideas that it would be interesting to focus on; I am thinking of newborns who do not understand articulate language and react to an internal feeling and let themselves be lulled by the sound of the voice of those who care for them(Language. An inner world). In their first year of life which is not characterized by verbal language, not only are they absolutely able to perceive the outside world with infallible sensitivity, but they develop their identity from birth and later their voice, which will then also be expressed with the use of language will be the representation of their internal image. It is this inner image that allows them to express themselves from birth even without the use of words.


The item “It is a sound (sound, noise or both) produced directly or indirectly by the human body with an informative or communicative value.” (O. Schindler, The voice. Physiology, clinical pathology and therapy)

It is sound when it appears (or rather perceives) as an acoustic signal characterized by 3 fundamental parameters: Height, Intensity, Timbre. It is generated through the passage of outgoing air in the expiratory phase (bellows) between the vocal cords (source) and the overlying resonance cavities (filters). For this to happen, anatomical and functional integrity of the organs that make up the bellows-source-filter is necessary.

It is noise in the presence of a source consisting of everything that is different from the vocal cords, we think of total laryngectomies in which you can have a “replacement voice” in which the source is the hypopharyngeal-esophageal tract that produces a noise that is articulated in word; or even “vicarious voice” in which the sound generator is constituted by a tracheo-esophageal prosthesis.

It is sound + noise in the presence of a source consisting of vocal cords that exhibit impaired functioning (all dysfunctional and / or organic dysphonies).

Dysphonia refers to a qualitative or quantitative alteration of the voice, for any cause. Dysphonia can have an organic or functional origin.

ORGANIC DYSPHONIA: disorder due to morphological or neuromuscular alterations of the three apparatuses responsible for vocal production, specifically anatomical alterations affecting the glottic plane or vocal cords, outcomes of laryngeal oncological surgery, motility disorders affecting the recurrent nerve, neurological disorders.

DYSFUNCTIONAL DYSPHONIA: disturbance of phonatory behavior linked to a lack of coordination of the various organs responsible for phonation in the absence of morphological, neuromuscular and motor disturbances.

MIXED DYSPHONIA: combined disorder of diagnostic difficulty and greater therapeutic complexity.

I would like to conclude by personally thanking Dr. Giuliana Pisanu for her valuable contribution and in the hope of having aroused interest in exploring such a vast and fascinating topic, I leave you the words of a person very dear to me: “I know how you feel, I recognize it from your voice.”

Valeria Verna


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Credits by: Polina Kovaleva
“…One by one they speak in the presence of many and I listen by observing the expression of the face, the tone of the voice more or less high or low, the posture. At the sound of the voice, images are born in my mind..” Massimo Fagioli