Voice Evaluation


  • Initial Assessment

  • Case History

    • Duration and onset of problem

    • Voice demands and occupation

    • Medical history

    • Vocal hygiene (water/caffeine intake, smoking)

    • Previous treatments

    • Additional questions for singers

    • Medication review (reflux medications, antihistamines, etc.)


  • Self-Assessment Tools

    • Voice Handicap Index (VHI and VHI-10)

    • Pediatric Voice Handicap Index (pVHI)

    • Voice-Related Quality of Life (V-RQOL)

    • Singing Voice Handicap Index (SVHI)

    • Reflux Symptoms Index (RSI)

    • Cough Severity Index (CSI)


  • Auditory-Perceptual Assessment

    • Gold standard in voice evaluation

    • CAPE-V or GRBAS scales used to assess:

      • Roughness

      • Breathiness

      • Strain

      • Pitch

      • Loudness

      • Overall severity


  • Physical Examination

    • Oral Mechanism Exam

    • Assessment of structural/motor deficits

    • Evaluation of face, oral cavity, head, neck structures

    • Testing of sensation and muscle function


  • Palpation of Extrinsic Laryngeal Muscles

  • Suprahyoid muscles assessment

  • Infrahyoid muscles evaluation

  • Muscle tension severity

  • Laryngeal positioning


  • Postural Assessment

    • Stance evaluation

    • Shoulder symmetry

    • Impact on respiratory function

    • Collaboration with physical therapy when needed

Respiratory Assessment

  • Breathing patterns (Abdominal, Thoracic, Clavicular)

  • Maximum Phonation Time (MPT)

  • s/z ratio for glottal insufficiency

  • Maximum Expiratory/Inspiratory Pressure (MEP/MIP)

  • Coordination of respiration with phonation

  • Instrumental Analysis

    • Laryngoscopic Examination

      • Videoendoscopy - STRUCTURE y non-vibratory functions

      • Videostroboscopy - VIBRATION

        • CAMPS evaluation (Closure, Amplitude, Mucosal wave, Periodicity, Symmetry)

      • Rigid vs. flexible endoscope options

    • Acoustic Assessment

      • Multi-Dimensional Voice Program (MDVP)

      • Parameters measured:

        • Jitter and Shimmer

        • Harmonic-to-Noise Ratio

        • Fundamental Frequency

  • Aerodynamic Assessment

    • Airflow rate

    • Subglottic pressure

    • Vital capacity

    • Phonation threshold pressure


  • Additional Considerations

    • Hearing status evaluation

    • Stimulability testing for treatment planning

    • Documentation and standardization

    • Collaboration between SLP and ENT

    • Setting-specific variations in evaluation procedures

Professional Roles

  • Speech-Language Pathologist

    • Comprehensive voice evaluation

    • Diagnosis of dysphonia

    • Stimulability testing

    • Voice therapy provision

    • Cannot prescribe medications

  • Otolaryngologist (ENT)

    • Complete medical examination

    • Laryngoscopic examination

    • Medical diagnosis

    • Surgical intervention when needed

    • Medication prescription

    • Referral to other specialists