How is a Voice Problem Evaluated?

Initially, the doctor will question you in detail about your voice, and generally focus on two areas: precise details concerning the problem for which you are seeking help, and the nature and extent of your usual voice use. Reviewing the questions you are likely to be asked before your visit may help you give more thorough answers.

The Problem Itself

• How is your voice different from normal?
• How long have you noted a voice change?
• How did you first become aware of a problem?
• Does it affect your voice during quiet conversation? Public speaking? Telephone use? Singing?
• Is the problem always present, or only from time to time?
• What makes the problem worse? Better?
• Is there any pain, or difficulty swallowing or breathing?

Background Information

• What do you do for a living?
• Do you use the telephone a lot?
• Do you have to make yourself heard over background noise often?
• What is your schedule of professional commitments (for performers and public speakers), both ongoing and upcoming?
• Do you smoke?
• Have you had voice problems in the past?

It can be difficult to describe a voice problem. “Hoarseness” is a term that means different things to different people, and can encompass a variety of problems. Being as precise as possible helps the doctor to understand what to look for.

• Is the voice rough or raspy?
• Is it airy or breathy?
• Is it strained or strangled?
• Is it difficult to speak loudly or to be heard over background noise?
• Do you feel that it takes unusual effort to use your voice?
• Does your voice get worse the more you use it?
• Is it worse at high or low pitch?

The physician will likely also ask for information regarding general medical problems and previous surgeries you may have had. Some of this information may seem irrelevant, but occasionally it contains important clues that lead to the nature of the problem. Offering a detailed history ensures that your physician can be as accurate as possible in making a diagnosis, establishing the cause of the problem, and tailoring treatment to you.

Throughout your examination, the doctor will be listening to your voice itself, as much as what you are saying. The quality of the voice itself – fluency, pitch, volume, smoothness – helps the physician form a preliminary impression of what type of problem might be present. This in turn helps determine what kinds of tests will be done.

Following a discussion of your history, the doctor will usually perform a complete head and neck examination, which is particularly important for smokers. You may be asked to give a voice sample by repeating sounds or phrases. The examination then turns to the larynx and vocal folds.