How will the doctor determine what is wrong?
Initially, the doctor will take a careful history – that is, question you in detail about your voice. The questions will 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.
Principal Aspects of the History of a Voice Disorder
The problem itself . . .
- What bothers you about your voice?
- 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 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?
- For performing artists and public speakers, what is the schedule of professional commitments, 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.
Some Aspects of Voice Problems
- 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 effort to voice?
- Does the 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 to the nature of the problem. The more detailed a history a person can offer, the more accurate the physician can be in making the diagnosis, in establishing the cause of the problem and in tailoring the treatment to the individual.
Following the history, the doctor will usually perform a complete head and neck examination, which is particularly important in 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.