Diagnosis
Table 1. Preoperative Voice Assessment Chart
1. PATIENT SELF-REPORT
a. Ask the patient if their voice has changed or been limited in:
i. Pitch
1. During conversation (eg, higher or lower than typical)
2. Range
3. During singing
ii. Loudness
1. During conversation
2. Range
3. Ability to speak over background noise (eg, reduced endurance or ability)
iii. Quality
1. During conversation
2. During singing
3. During different times of day
4. With longer durations of talking
b. Administer a self-assessment tool such as the Voice Handicap Index
2. AUDITORY-PERCEPTUAL ASSESSMENT
a. Surgeon subjective opinion or rating of overall degree of voice aberrance can be recorded
in the chart. An example of such a rating might be:
i. Normal = The patient's voice sounds clear and of expected pitch and loudness
ii. Mild abnormality = minimal but noticeable abnormality in voice quality
iii. Moderately abnormal = noticeable abnormality in voice quality that is sometimes
distracting
iv. Severely abnormal = obviously abnormal voice that is distracting
b. Scales normally used by speech language pathologists, such as:
i. GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain)
ii. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)
3. AUDIO RECORDING OF THE PATIENT'S VOICE
a. Referral to a speech-language pathologist with voice expertise is preferable for optimal
voice recording
b. At the minimum, a HIPAA-compliant voice recording using a smartphone or other
audio recording device may be adequate
c. Recording suggestions
i. A quiet environment is important
ii. Place the microphone near the patient's mouth (eg, within 4 cm)
iii. Record a variety of speaking tasks such as
1. Sustained voicing of "ah" and "ee" for 3-5 seconds each
2. Standard sentences or passages:
a. Read or repeat the following sentences aloud:
i. The blue spot is on the key again
ii. How hard did he hit him?
iii. We were away a year ago.
iv. We eat eggs every Easter.
v. My mama makes lemon muffins.
vi. Peter will keep at the peak.
b. Alternatively, ask the patient to read "The Rainbow Passage"
a
or other standard
passages such as found at the website: http://www.d.umn.edu/~cspiller/
readingpassages.html
3. Conversational recording : Ask the patient to describe how their voice is
functioning or talk about a favorite vacation for 30 seconds to 1 minute.
a
From Fairbanks G. Voice and Articulation Drillbook. 2nd ed. New York: Harper & Row; 1960: 124-139.
