Healthcare: Ear, Nose and Throat (Otolaryngology)

Voice Problems and Assessment


How Do I Know if I Have a Voice Problem That Should Be Evaluated by a Laryngologist?


Many people are unsure if they should see a medical professional about their voice. Individuals with voice disorders often complain of the following symptoms:

  • Friends and family have mentioned that you sound different.
  • People frequently mention that you sound sick when you are not.
  • You may feel discomfort in your throat when you talk.
  • You feel it takes increased effort to talk.
  • Your throat feels tired after you have been talking for a long time.
  • Your voice "gives out" when you are talking for a long time.
  • You have difficulty being heard over background noise.
  • You may notice that you need to clear your throat frequently.
  • You have a persistent, dry cough that is unrelated to any other signs or symptoms of illness.
  • You have noted a change in your voice or the above symptoms for longer than 3-4 weeks.

How Does a Laryngologist Evaluate the Voice?


The visit always begins with a thorough history of your voice complaint. The laryngologist will also review your past medical history, any medications you are taking, similar incidents, or previous voice procedures. You will also fill out a voice "quality of life" questionnaire. The laryngologist will perform a complete head and neck examination including the ears, nose, mouth and neck.

You will be asked to read a standard passage, which will be recorded. This allows comparisons of voice quality between visits and to help assess the impact of any interventions.


How Does a Laryngologist Evaluate the Larynx (Voice Box)?


In the office, we use mirrors or scope with lenses or fiber optics to visualize the larynx (voice box). This is known as indirect laryngoscopy. The advantage of scopes over the old fashioned mirror is that scopes give us a magnified view, and the images can be recorded.

Laryngoscopy is the examination of the larynx (voice box). This uses a steady light source and allows for the evaluation of vocal fold motion (opening and closing) as well as large lesions.

Stroboscopy uses a flashing light to slow down the apparent vocal fold vibrations. This allows us to evaluate more subtle lesions, anomalies in vibratory characteristics, and vocal fold closure patterns.

There are two types of scopes that can be used for both laryngoscopy and stroboscopy: rigid and flexible.

The rigid scope has a 70 degree angled lens and is inserted into the mouth to visualize the larynx (voice box).

The flexible fiber optic scope is 3.4mm in diameter. The nose can be sprayed (optional) with a combination of a decongestant spray (Neo-Synephrine) and numbing medicine (Lidocaine). The scope is then inserted into the nose and into the throat.