Use of this model requires the clinician to follow an orderly analysis of the possible causes for an individual's dysphonia and to adhere to a concept of multiple etiological factors that interact with each other.

The following 6 statements are premises that are generally accepted as axioms that are helpful to have in mind when evaluating the patient with a voice disorder:

1. Voice production is an athletic skill requiring coordination of muscle systems throughout the body. A column of air under relatively low pressure must flow upward through the trachea past vocal folds that are held in adduction with a force appropriate to the task. The upper vocal tract resonators are adjusted to provide amplification and the desired tonal focus and articulatory targets.
   
   
2. Some individuals are naturally skillful vocal athletes, most are average, and a few are lacking in vocal technical ability. The levels of skill tend to follow a normal distribution curve such as shown in Figure 1. Individuals with good voice skills are less likely to become dysphonic in response to psychological distress or to structural changes of the vocal folds than are those at the "poor" end of the spectrum.
   
   
3. Speaking or singing with poor technique will lead to more wear and tear on the vocal folds than will the same amount of loud or aggressive voice produced with skill. Younger adult vocal cords are more resilient than are older ones, therefore older voice users need to be smarter and more skillful to avoid damage.