The Voice Oriented Examination

• History
• Vocal Capability Battery (VCB)
• Physical Examination (videolaryngoscopy)

These three parts of the patient encounter are the necessary and sufficient components to accurately diagnose a voice disorder. If you skip one part of the exam, it greatly diminishes your clinical accuracy so each part is necessary. When you have completed all three parts you generally need not perform additional testing to arrive at a diagnosis.

During each part of the voice oriented exam, a primary diagnosis is made, perhaps keeping one or several secondary possibilities in mind. Remake a diagnosis on each part of the exam. After the Vocal Capability Battery make a primary diagnosis. If it is in disagreement with the diagnosis from the History, then gather more historical information until the two are compatible. You may still have a rank of more than one possible diagnosis but they will be disease states that have similar characteristics. On the third part of the examination, the Videolaryngoscopy, look until you find what you expect. It is there. If you do not appreciate what you expect, then go further with your videolaryngeal examination, for example by applying additional local anesthesia and visualizing nooks and crannies of the larynx.

When all three parts of the exam triangulate or point to the same diagnosis, then the physician can, with completely certainty, tell the patient what they have. You don’t believe any medical problem can so easily wrapped into such a tight little package. Well, follow along.

First lets look at the broad categories of disease that affect the voice. There have been many attempts at classifying voice disorders and here is yet another. The attempt in this classification is to separate diseases by causal process. This categorization is helpful since the first step of any exam is history taking and a large part of the history is pointed at gathering data to support the likely cause of the disease. The patients behavior is observed to see if it points to a cause, temporal cues are gathered to correlate the onset with a causal event and associated symptoms are determined to establish the existence of some disease complex as the cause.