Knowing what to target when a patient presents with a breathy voice is a general question, but equally a good one to ask. Some people will have breathy voices for a variety of different reasons and so the first thing I would do is ascertain whether or not they have a diagnosis.
Generally breathy voices arise because the vocal cords are not closing as they should. This is something that someone might be able to actually learn how to do themselves which even though might soften the voice, its certainly not an efficient way of using it as you are losing air through the gap created in your vocal cords. Whatever the reason might be for a breathy voice, I would often first ask the patient to target closure exercises.
There are different types of exercises that might help you to close the vocal cords but just for example; doing a vowel onset using the /A/ sound and bringing the cords together, you hear a very light clicking sound at the start which is necessary in speech quality in order to bring the vocal cords together.
If this clicking sound is too harsh however it might be easy to mistake it with what’s know as hard glottal attack. If a patient were to present with hard attack like that, you would instead look to normalise to a normal glottal stroke where the vocal cords are touching together lightly and briefly before the vowel is exposed. Without the normal glottal stroke you will simply be presented with the sound of air coming through. If the attack is too harsh you may instead be presented with more of a “bang” which is indicative of too much pressure.
Voice is something which needs to be in balance and when it’s working well you often won’t think of these things. However when voices start to go wrong, either from not having enough closure of having too much, those are the sorts of things which we as speech and language therapists try to put back into balance and into normal closure. Bringing the vocal cords together without “banging” them together is the key.