This is the second article in a three-part series on voice disorders.
A person with a voice disorder may begin by noticing that their voice feels tired or that their voice just isn’t the same as it used to be. Singers may find that they are unable to reach the high notes of their range. There are usually two main professionals involved in a voice evaluation, although additional team members may be added as appropriate. The first is an ear, nose, and throat (ENT) physician. The ENT will generally perform a laryngoscopy or videostroboscopy. Each of these procedures allows for the ENT to actually see the vocal folds and what’s happening. They can see if the muscles are tense and if the vocal folds are moving properly. Is one vocal fold moving more than the other? They will also investigate if there are contributing factors, such as reflux, to the person’s voice difficulty. The ENT may recommend medications to help with contributing factors.
The other professional involved is typically the speech-language pathologist (SLP). The SLP’s role is to evaluate the quality of the person’s voice and investigate the impact of the voice disorder on the person’s life. The impact of a voice disorder is individual to each person and is influenced by the severity of the disorder, voice use, and the person’s thoughts and perceptions. An evaluation by an SLP may be comprised of two main parts: auditory-perceptual measures and acoustic measures. Auditory-perceptual measures primarily involve a trained SLP listening to the person’s voice. This is how the voice is “perceived.” Auditory-perceptual measures allow the SLP to assess a person’s pitch, loudness, and overall quality in different contexts, such as saying “aaaaaaa” or while talking. The SLP will also observe the person’s speaking style- do they have signs of tension in the throat? Is the person using appropriate breath support, or are they talking for long periods without taking a breath?
Additionally, acoustic measures may be utilized during the evaluation with the SLP. This allows the SLP to obtain actual numbers pertaining to pitch, loudness, and information regarding cycles of vocal fold motion. Generally, the vocal folds move in sync, with both folds moving at the same pace. However, with a voice disorder, the cycles may become asymmetrical. For instance, one fold may move more than the other. Extra tension or mass on the folds may create a lag or less movement, which then results in a voice change. Perceptual and acoustic measures are supported by the ENT’s diagnosis, which allows the patient to move forward with the most appropriate treatment plan. Additionally, during the evaluation, the SLP completes stimulability testing. This is basically where the SLP has the patient try out different therapy techniques to see which one is most appropriate for the patient. At this point, a determination for therapy candidacy is made.