Evaluation of Individuals with Voice Disorders

Evaluation of the individual with a voice disorder ("dysphonia") is best seen as a multidisciplinary endeavour. The transdisciplinary approach provides the advantage of allowing clinicians from a variety of professions to cooperate in the assessment, bringing different areas of expertise and perspective to the task, while they dilute each others' reductive clinical biases. A myriad of clinical tools are available to help describe, document, and measure features of voice dysfunction, not the least of which are the clinicians' ears, eyes, and hands. In the years ahead, we will no doubt have access to increasingly refined clinical instrumentation. Nevertheless, machines can never replace the skills and perceptions of the experienced clinical team evaluating a "living-breathing-emoting-vocalizing" human.

During the multidisciplinary assessment, four categories of factors that may contribute to voice disorders are considered:

1. technique or level of vocal skill
2. lifestyle
3. psychological status
4. gastro-esophageal reflux.

Because these 4 areas are represented in multidisciplinary discussions so frequently - and generally need to be considered in the treatment protocol - we have developed a model for the management of individuals with voice problems based on these etiological platform components.

A Model for the Evaluation of Dsyphonia

Principles

This model of dysphonia should help the clinician work through a difficult voice evaluation and come up with a truly helpful treatment plan. Often a number of interrelated factors are involved in the etiology, and all require treatment.

Our model purports that dysphonia in all individuals with voice disorders is built on a platform with 4 components, and each component affects the dysphonia to some degree. The platform components are (1) technique and level of vocal skill; (2) lifestyle and matters pertaining to occupation and regular activity; (3) psychological factors, including personality and emotional stressors; and (4) gastroesophageal reflux. A primary pathology, such as neuromuscular or mucosal disease may lie over the platform created by the 4 interactive components. The impact of the 4 platform components is estimated first, then the presence of a primary pathological process is considered, and the manner in which it interacts with the underlying platform is determined. A treatment program subsequently is planned to take all the relevant factors into account.