الفهرس 
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Abstract
Voice is the complex, dynamic product of vocal fold vibration that allows us to vocalize (i.e. make sound) and verbalize (i.e. produce language through speech) (Justice, 2006). The basic task of the voice is to act as a carrier wave of verbal communication (Vilkman, 2000). Control of voice is an essential component in the individual’s ability to adjust the social situation, to make good contact and maintain equilibrium in relation to the audience.
Voice disorders are characterized by abnormalities in pitch, loudness, and/or quality of the voice that can limit the effectiveness of oral communication. In order to produce a normal voice, the laryngeal function must be coordinated, efficient and physiologically stable. Any imbalance in this delicate system affects vocal quality. When the vocal quality deteriorates and both anatomical and neurological etiologic factors are excluded, a functional voice disorder should be suspected. Functional voice disorders account for at least 40% of the cases of dysphonia referred to multidisciplinary voice clinics. They occur predominantly in women (Werning et al., 2007).
The prevalence of voice disorders among teaching staff was 57%. The most prevalent lesions were phonasthenia “vocal overstrain” (18%), nodular lesions (14%), and hyperfunctional dysphonia (8%). The incidence rate was 3.87 new cases per year per 1000 teachers. Women had organic lesions three times more than men. However, men had chronic laryngitis three times more than women and functional dysphonia nearly twice more than women. There was significant risk of suffering voice disorders in teachers who smoke daily and who drink several cups of coffee or tea. It is advisable to carry out an annual evaluation of all teaching staff on account of the high prevalence of voice disorders among them (Julián et al., 2008).
The process of voice therapy provides a variety of therapeutic techniques that can teach individuals to develop voice habits that will preserve a resonant and healthy voice. These techniques may include vocal hygiene and voice conservation as hydration, yawn sigh, and voice relaxation to wear away any defects in the larynx that may be causing a voice disorder (Theiss, 2010).
In order to completely benefit from the process of voice therapy to prevent voice disorders in the future, it is crucial that an individual practices the therapeutic techniques that voice therapy advises regularly (Phillips, 2012).
According to Sharma et al. (2016), the most commonly used therapy techniques are Smith Accent Method and Resonance Tube Therapy.
The Smith Accent method of voice therapy uses rhythmic exercises to facilitate the coordination of minimally-constricted vocal fold vibration with appropriate air pressure and air flow. The SA method is a holistic approach that addresses pitch, loudness and timbre simultaneously, rather than focusing separately upon each of these vocal parameters (Sharma et al., 2016).
On the other hand, RTVT is a method of phonation into glass tubes keeping the free end of the tube in water in a plastic container (Laukkanen, 1995). Tube phonation has been used, for example, for treatment of hypernasality (Habermann, 1980) and (Bele, 2005). Sovijärvi in (1965) was at first interested in testing different kinds of glass tubes in the children with hypernasality, but soon he started to use the tubes also with adult singers who had voice problems.
The purpose of this work was to compare the effectiveness of RTVT and SA method of voice therapy in the rehabilitation of hyperfunctional dysphonia patients. The overall effectiveness of voice therapy was measured by the changes in APA, laryngeoscopic examination, voice related QOL measures and acoustic voice analysis.
Comparing the outcomes measured before and after therapy for each group separately, the following showed statistically significant improvement post-treatment for both groups: grade of dysphonia, voice quality, vocal fold redness, Arabic VHI, Jitter %, Shimmer %, Noise to Harmonic ratio. While voice pitch, vocal fold edema and phonatory gap showed statistically significant improvement post-treatment in the RTVT group only.
Each of the voice therapy technique has successfully improved patients with hyperfunctional dysphonia. The results of both therapy techniques were comparable in improving these patients, in terms of grade and character of dysphonia, laryngeoscopic findings, VHI and acoustic analysis.
We recommend another study that includes more patients with abnormal voice pitch would be useful to further analyze how each voice therapy program would change pitch abnormalities.