What to do when medicine is no longer enough?

When a voice disorder sets in, it is no longer limited to a simple, temporary discomfort. The voice becomes fatigued, loses stability, power, or sound quality. For many people facing vocal pathologies, the journey begins with consultations with a phoniatrician, an ENT specialist, or a speech therapist, with the legitimate goal of understanding, securing, and treating the problem.

The period of uncertainty after a vocal pathology diagnosis

A recurring observation emerges among people with voice disorders or pathologies: medical examinations are reassuring, assessments are described as “normal,” yet the voice remains difficult to use on a daily basis. Speaking becomes exhausting, fatigue appears quickly, and the sense of vocal control seems durably altered.

This situation generates real and often misunderstood frustration:

• The vocal fatigue persists, compensatory mechanisms develop, and a loss of confidence is progressively added to the initial disorder.
• The pathology is medically stabilized, but vocal function does not follow in real-life use as you would expect.

Functional support, not medical treatment

It is essential to establish a clear framework: the support offered here does not, under any circumstances, fall within the medical field. It is complementary to the follow-up provided by healthcare professionals, once the situation has been evaluated, diagnosed, and deemed stable.

• I do not provide any medical diagnosis.
• I do not treat or cure vocal pathologies.
• I do not replace the phoniatrician or the speech therapist.

The approach is exclusively functional.
It focuses on real-life voice use:

• breath–phonation–resonance coordination,
• compensatory strategies,
• and the perceptual quality of the voice in everyday life.

Where medical care secures anatomy and rehabilitation aims for a return to a clinical norm, vocal support works on how the voice actually functions in the body, over time, and in real-life contexts.

Who is this complementary approach for?

This page is intended for people living with specific disorders:

• Sulcus or vocal fold scarring.
• Tension dysphonias.
• Parkinson’s disease.
• Post-cochlear implant voice rehabilitation.
• Support during adolescent voice change.
• Transient adolescent dysphonia.
• Support for transgender individuals (feminization and masculinization).

Each condition is linked to a dedicated page to explore complementary, respectful, and non-invasive solutions.

To go further: to understand the difference between medical care and coaching, consult my article: Why a vocal coach rather than a phoniatrician or a speech therapist?

When medicine has done its job… but the voice remains fragile.

In many complex vocal journeys, a frustrating scenario repeats itself. The vocal pathology has been identified, explored, and sometimes treated. Yet as soon as conditions become demanding (stress, noise, duration), the voice locks up or fatigues instantly.

Everything seems “normal” on paper, while the voice itself no longer follows.

Why a normal examination does not guarantee a functional voice

This discrepancy is not a diagnostic error by your phoniatrician. It simply reflects the limits of the medical framework. Examinations primarily assess the anatomical state of the vocal apparatus:

• Laryngoscopy and nasofibroscopy: check vocal fold mobility.
• Stroboscopy: analyzes the quality of mucosal vibration.

These tools are essential to rule out progressive risk. However, they say nothing about how you use your voice under pressure, during a two-hour meeting, or in a noisy environment.

A “clinically acceptable” but socially insufficient voice

This is often the turning point after speech therapy. Speech-language rehabilitation in vocal pathologies aims to make the voice:

1. Intelligible (you are understood).
2. Non-damaging (you no longer injure yourself).
3. Compliant with a clinical norm.

However, a clinically correct voice may remain unstable, weakly projected, or poor in expressive terms. It works “at rest,” but lacks safety margin and freedom for social and professional life.

The limits of optimization within medical care

Speech therapy focuses on prevention and return to norm. But certain essential dimensions of vocal performance often remain unexplored:

• Long-term endurance: sustaining a full day of speaking.
• Acoustic aesthetics: rediscovering a voice that feels like your own.
• Management of peripheral tensions: eliminating chronic cervical or mandibular rigidity.

It is precisely within this space of optimization, after the phoniatrician has secured and stabilized the situation, that specialized support becomes meaningful.

The specific role of the vocal coach in vocal pathologies

My positioning is clear: I never intervene as a substitute for a physician. The work takes place after diagnosis by the phoniatrician or alongside validated speech therapy follow-up.

Where medicine secures and speech therapy normalizes, coaching intervenes on real and sustainable voice use.

A holistic approach: beyond the vocal folds

Focusing solely on the larynx is reductive. The voice engages the entire body. When peripheral muscular chains are tense, coordination becomes unstable and fatiguing.

Extralaryngeal musculature: a major lever

To restore healthy vocal function, locking points must be released:

• The jaw: hypertonicity reduces resonance space.
• The tongue: its positioning directly influences vocal clarity.
• The floor of the mouth: crucial for support, particularly in cochlear implant cases.
• Cervical spine and shoulders: they condition laryngeal mobility (essential in Parkinson’s disease).

These locking points are directly connected to the intralaryngeal musculature responsible for voice production.

The intralaryngeal musculature: stabilizing phonation

Once extralaryngeal tensions have been released, the work can refocus on the intralaryngeal musculature, which is directly involved in voice production.

These muscles control vocal fold adduction, vibratory stability, and the regularity of phonatory emission. When they are required to compensate for peripheral blockages (jaw, tongue, cervical region), phonation becomes unstable and fatiguing.

By rebalancing the entire system, it becomes possible to fine-tune these adjustments without forcing:

• more stable glottal closure,
• more regular vibration,
• improved vocal endurance.

This coordination between extralaryngeal and intralaryngeal musculature allows for optimal sound propagation within the resonators. The voice gains in clarity, amplitude, and comfort, while remaining fully usable over time.

Resonance and aesthetics: optimizing projection

Resonance is the key to a voice that carries effortlessly. It allows sound projection without creating excessive pressure on the larynx.

Voice placement

The work consists in refining the adjustments so that phonatory emission is stable and economical. This makes it possible to avoid “pushed” or “compressed” voices, which often result from compensatory mechanisms linked to a pathology.

Perception by the listener

A voice may be medically stable yet perceived as monotonous or fatiguing. Coaching integrates this dimension: how is your voice received? The objective is to bring greater clarity, comfort, and impact to your existing vocal identity.

Key takeaway : Where rehabilitation aims at intelligibility, vocal coaching explores acoustic performance and long-term comfort, once the medical framework has secured the situation.

Non-invasive vocal assessment: understanding before acting

When reaching this stage of the vocal journey, one question comes back repeatedly, almost always with concern: “What should be done when medicine is no longer enough?” The examinations have been carried out, the diagnosis has been established, the situation is considered stable… and yet the voice remains fragile, unstable, or difficult to use in real-life situations.

It is precisely at this point that a non-invasive vocal assessment can bring clarity, without adding stress, without further medicalizing the situation, and without calling into question the work already carried out by healthcare professionals.

Here, the word “diagnosis” has no medical meaning. It is neither about identifying a pathology nor about assigning a clinical label. The objective is simply to understand how your voice functions today, which strategies it uses to produce sound, and at what cost to your body.

This approach is intended for people who have already consulted extensively, who know that “everything looks fine on paper,” but who feel that something is still not functioning properly in the everyday use of their voice.

An acoustic analysis to objectify the voice, without medicalization

The first step is based on an acoustic analysis of the voice. It makes it possible to observe measurable parameters, without ever claiming a medical interpretation. The aim is not to determine whether your voice is “ill” or “healthy,” but to describe how it actually behaves.

This analysis may focus on:

• the stability of the fundamental frequency,
• the richness and distribution of harmonics,
• variations in intensity,
• the capacity for modulation and adaptation.

These data make it possible to put words, and sometimes numbers, on sensations that are often difficult to explain: a voice that gives out, that fatigues quickly, that becomes unstable under stress, or that no longer “carries” as it once did.

Objective measurements to clarify, not to alarm

The value of these measurements lies precisely in moving out of vagueness and self-judgment. Many people believe that they are “forcing incorrectly,” “breathing incorrectly,” or that they “can no longer manage.” Objective measurements, on the contrary, make it possible to understand what is actually happening, without guilt.

No medical promise is made, and no prognosis is established. These tools are used solely to guide vocal work, to identify priority axes, and to build a coherent form of support that respects your vocal history.

Comparative listening: before / after, to restore reference points

One of the most reassuring aspects of this approach relies on comparative listening. Being able to hear one’s own voice, before and after certain adjustments, often makes it possible to regain confidence.

The aim is not to seek a “perfect” voice, but to perceive concrete evolutions:

• a more stable emission,
• a less constricted voice,
• freer resonance,
• less rapid onset of fatigue.

This comparison helps to move out of the feeling of impasse in which many people find themselves after a long medical or speech-therapy pathway. It shows that margins for progression still exist, without calling into question what has already been done.

Mapping compensations in order to release them more effectively

Finally, this non-invasive vocal diagnosis makes it possible to map the compensations that your voice has put in place over time. These compensations are never errors: they are vocal survival strategies.

Jaw hypertonicity, overactivation of the tongue, cervical tensions, poorly distributed breath… These mechanisms make it possible to continue speaking, but they often end up exhausting the voice.

Identifying them clearly makes it possible to stop struggling blindly. Vocal work can then be oriented toward greater comfort, greater bodily coherence, and a more reliable voice in everyday use, without ever substituting for the medical framework.

This stage often constitutes a turning point in the vocal journey: not a new diagnosis, but a precise and reassuring understanding of what can still evolve, here and now.

Vocal pathologies and vocal disorders supported

This section constitutes the core of the hub page. It is intended for individuals presenting with identified or stabilized vocal disorders, who are seeking to understand which functional work pathways exist beyond the strictly medical framework.

Each pathology or disorder refers to a dedicated page, making it possible to explore in greater depth the mechanisms involved and the possible axes of support, within a complementary and non-invasive logic.

Sulcus vocalis

Sulcus vocalis is characterized by a breathy voice and rapid vocal fatigue. The support focuses on optimizing vocal efficiency and reducing compensatory mechanisms in order to restore an effective voice without strain.

➡️ Discover support for sulcus vocalis

Muscle tension dysphonia or primary functional dysphonia

The disorder: Muscle tension dysphonia is based on a chronic hyperfunction of the vocal apparatus. It manifests as a constricted, unstable voice or rapid vocal fatigue, often accompanied by cervical tension, even when medical examinations reveal no lesions.

The disorder: Muscle tension dysphonia is based on a chronic hyperfunction of the vocal apparatus. It manifests as a constricted, unstable voice or rapid vocal fatigue, often accompanied by cervical tension, even when medical examinations reveal no lesions.

➡️ Learn more about muscle tension dysphonia

Spasmodic dysphonia (adductor / abductor types)

The framework: A neurological disorder of central origin, spasmodic dysphonia requires prior medical management. My role here does not fall within the field of care, but within functional support, in order to optimize voice use in complement to medical treatments (such as botulinum toxin injections).

Functional support: The exploration focuses on what remains modulable: developing adaptation strategies, identifying spasm triggers, and working on resonance. The objective is to regain a more stable vocal aesthetic and everyday communicative comfort, despite the pathology.

➡️ Spasmodic dysphonia

Parkinson’s disease

Vocal symptoms: Parkinson’s disease often leads to hypophonia (reduced loudness), monotony, and a loss of intelligibility. These difficulties in maintaining stable vocal energy directly impact self-confidence and social connection.

Vocal symptoms: Parkinson’s disease often leads to hypophonia (reduced loudness), monotony, and a loss of intelligibility. These difficulties in maintaining stable vocal energy directly impact self-confidence and social connection.

➡️ Vocal support and Parkinson’s disease

Voice and cochlear implants: functional approach

The vocal challenge: The cochlear implant provides restored hearing, but auditory feedback remains different from natural perception. This can lead to vocal instability or a lack of acoustic aesthetic quality (metallic or poorly timbred voice), even when articulation is technically correct.

Functional support: The work is based on proprioceptive adjustment (feeling the voice rather than only hearing it) and motor reorganization. The objective is to build a more reliable, comfortable, and harmonious voice, for smoother communication with others.

➡️ Voice and cochlear implants: fonctional approach

Support during adolescent voice change

The phenomenon: Voice mutation is a period of major physiological instability during which the voice may derail or “break.” For highly vocal adolescents or those passionate about singing, this loss of identity and auditory reference points can be a source of stress and fatigue.

Functional support: The objective is to secure voice use in order to prevent the installation of compensatory patterns (forcing). By working on the management of the new larynx, I help the adolescent go through this phase with comfort, confidence, and a better understanding of their instrument in transformation.

➡️ Vocal support during adolescent voice change

Vocal coaching for transgender individuals

The identity-related issue: The voice is an essential pillar of transition and lived identity. Beyond frequency (pitch), the expression of gender identity passes through resonance, prosody, and rhythm, which influence the overall perception of the voice by others.

Functional support:
I offer respectful and individualized work to align your voice with your lived identity. The approach is progressive: it aims to explore new acoustic balances without muscular forcing and without imposing any predefined norm, with full respect for your vocal comfort.

➡️ Vocal support for transgender individuals

Who this support is appropriate for… and who it is not

This approach is based on a clear and secure framework. It is intended for individuals whose medical situation is known and stabilized, and who are seeking to improve the real-life use of their voice, without entering a therapeutic care pathway.

This framework allows preserving confidence, safety, and consistency of the vocal journey. The proposed accompaniment is inscribed in a logic of complementarity, never as a substitute for medical care.

An ethical collaboration with the medical field

Functional vocal coaching is only relevant if it is embedded in a complementary relationship with the medical pathway. The voice involves health issues that require, upstream or in parallel, a diagnostic framework established by qualified professionals.

The principle of complementarity: The work proposed here acts as support and never replaces the follow-up of a phoniatrist, ENT specialist, or speech therapist. Medical diagnoses are scrupulously respected: they constitute the foundation of the accompaniment.

Constant vigilance: In case of appearance of new symptoms or unusual evolution, referral to the medical field is systematically prioritized. This ethics ensures the safety and consistency of your journey.

The objective: a common language between disciplines

• Medicine secures and heals.
• Rehabilitation normalizes function.
• Vocal accompaniment optimizes the real, durable, and artistic use of the voice.

Taking the first step: the functional vocal assessment

If your medical situation is known but your voice remains limited or fatiguing, this first appointment allows taking stock of your compensation mechanisms and your margins for improvement.

What this first session includes:

• Analysis and listening: A dedicated time to understand your daily vocal usage.
• Clarification: Determining whether functional accompaniment is the suitable solution for you.
• Secured framework: This appointment does not replace a medical diagnosis.

Booking is only validated if the framework is clear, shared, and perfectly adapted to your situation.

Cost of a vocal assessment: €250, in-person or remote