Lifestyle and Occupation

Consider how general behavioral patterns may affect the voice. Specifically, one would want to know about:

• excessive talking or singing in poor acoustical environments, such as night clubs, swimming pools, gymnasiums, moving vehicles, or outdoors
• general talkativeness
• smoking
• occupational voice demands

Psychological Factors: Personality and Emotion

Explore possible psychological factors in the production of the dysphonia by seeking in the history for evidence of:

• a traumatic event around the onset of the dysphonia
• difficulties in communicating with significant others
• suppression of expression of negative emotions, such as anger or sadness
• abusive relationships in childhood or later
• narcissistic preoccupation with voice
• overt anxiety or depression

Most people will agree that their voice difficulty gets worse at times of added stress. It is helpful to ask about which stressors seem to affect the voice most noticeably, because this may direct the interview to the source of psychologically based muscle misuse.

Gastro-esophageal Reflux and Associated Medical Conditions

Determine the relative importance of gastro-esophageal reflux in the dysphonia by evaluating symptoms such as:

• throat sensations in the morning
• waking at night coughing or choking
• habitual throat clearing
• the sense of a lump in the throat (globus pharyngeus)
• sensation of post-nasal drip
• sour, or acidic taste
• heartburn, or water brash
• asthma or other chronic breathing difficulties