How Are Voice Problems Diagnosed?

The health professionals who can give you the most specialised advice on voice problems are ear, nose and throat (ENT) surgeons and speech therapists. At Singapore General Hospital (SGH), diagnosis of voice problems is carried out at the interdisciplinary voice clinic where patients are assessed by both an ENT surgeon specialising in voice disorders (known as a laryngologist) and a speech therapist.

Patients usually begin by consulting their family physician or general practitioner who can advise them on the need for a referral to the voice clinic. Typically, if you have had symptoms for more than 3-4 weeks, then it is advisable to see a specialist. If your symptoms are short-lived but disrupt your lifestyle or work, then a specialist assessment may be helpful earlier.

An assessment of your voice problem will usually begin with the doctor taking a history to ascertain the nature of the problem and its impact on your daily life and occupation. Typically questions may include:

• How do you use your voice at work and in other settings?
• What other activities do you practise which could affect your voice?
• What other medical symptoms and conditions do you have?

You may then be asked to carry out a number of vocal tasks to help the doctor and speech therapist grade the severity of your voice problem. You may also be asked to fill in a simple questionnaire to rate the degree of your vocal handicap.

Further tests that help with diagnosis

An important part of the diagnosis is the endoscopic examination of the voice box. This examination allows the voice box and vocal folds to be viewed with a camera. It is performed by passing a thin flexible tube through the nose down to the level of the voice box. It can also be done by putting a tubular camera with an angled lens into the back of the mouth.

The endoscopic examination can be combined with a strobe light or high-speed video, enabling vibration of the vocal folds to be viewed in slow motion and high detail. A recording is normally taken which can be shown and discussed with you. The full examination is known as video-stroboscopy.

Such an examination is very straightforward and not too uncomfortable in most cases, so relax and do not worry unduly if you are considering having it done.

Other tests may facilitate the diagnosis in selected situations. These include 24-hour pH monitoring for acid reflux, laryngeal electromyography to measure muscle function, and sometimes even examination of the vocal folds under general anaesthesia. These more specialised tests are not carried out in every situation. The doctor will discuss them with you if required.