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Any condition that affects the performance of the voice-producing organ, the larynx, can cause a voice disorder. Usually, hoarseness is the main symptom, but laryngeal disorders can cause other more subtle problems.
Any hoarseness that persists beyond two weeks, especially in a smoker, should be evaluated by a physician who is trained to examine the vocal folds.
The impact of voice disorders can be highly subjective - that is, a serious problem for one person may present little difficulty for another. Some of this has to do with a given person’s expectations, but a key factor is vocal demand. Simply put, vocal demand describes the vocal requirements of a given person’s daily life. Clearly, a singer or an actor will have different vocal demands than a teacher or a trial attorney, who in turn will have different vocal demands than someone who does most of his or her work on a computer, or someone who cares for a hearing-impaired individual.
There is no established way to quantify vocal demand. Generally, however, the longer and the louder one must voice throughout the day, the greater the vocal demand and the more likely small irregularities in laryngeal function are to be troublesome. Also, different types of voicing – for instance, professional vocal performance – have lower tolerance for subtle changes in voice quality than others.
The professions most commonly evaluated for voice disorders are: performing artists, teachers, attorneys, salespeople and other customer service personnel.
Because voice quality is subjective and vocal demands vary, each person with a disorder is usually the best judge of the severity and importance of the problem (assuming it is non-cancerous), and whether it justifies a proposed treatment.
In benign voice disorders, the role of the physician is to make an accurate diagnosis and explain what options are available, including discussions of expected outcome and attendant risk. Needless to say, a physician who is fully informed of both a patient's symptoms and vocal needs is best equipped to offer advice tailored to an individual’s problem. Ultimately, a treatment decision - and especially the decision for surgery, if required - should be made together by patient and physician, taking into account vocal behaviors and vocal demands.
