Voice Evaluation


A “normal” voice is essential for effective communication. Breakdowns in voice can impact self-esteem, social interactions, work performance, and more. Characteristics of voice include:

  • Balance of oral and nasal resonance
  • Appropriate loudness
  • Appropriate pitch (not too high or too low)
  • Rate of speech coupled with respiratory support
  • Inflection (involving pitch and loudness)

These characteristics vary depending upon age, size, and gender. Social behaviors, culture, and dialects may also cause variations in voice.

What is a voice problem? If one or more of the five characteristics listed above is “abnormal”, then components contributing to a voice disorder could be, but are not limited to:

  • Organic: Structural anomalies or growths (for example, cysts or tumors) and/or paralysis of one or more nerves innervating the larynx (voice box). These could be congenital or a result of trauma.
  • Organic Changes Due to Vocal Abuse: Damage to vocal folds and/or larynx secondary to voice abuse (for example, shouting, yelling, screaming, cheering, excessive talking, throat clearing/coughing, inappropriate use of pitch, inappropriate loudness level, talking in a high noise environment, excessive alcohol or caffeine intake, smoking, sinusitis, allergies, hormonal changes, and chemicals/dust).
  • Functional: Voice is impaired, however, nothing is identified in the vocal folds or larynx as abnormal. Functional voice problems may be psychological or a result of imitation of others (especially in children).


In order to successfully diagnose and treat voice disorders, it is highly recommended that a “team” be established among specialists, which should include a speech-language pathologist, an ear-nose-throat physician (otolaryngologist), an audiologist, a psychologist, a dentist/orthodontist, a neurologist, and a primary care physician.

  • ENT referral first, to assess integrity of vocal folds
  • If medical intervention is not needed, ENT often refer to SLP for voice evaluation
  • Upon completion of medical intervention, the physician may refer to SLP to ensure appropriate vocal hygiene and vocal use to maximize residual voice production