Phoniatrics I pp 349-430 | Cite as

Diagnosis and Differential Diagnosis of Voice Disorders

  • Wolfgang AngersteinEmail author
  • Giovanna Baracca
  • Philippe Dejonckere
  • Matthias Echternach
  • Ulrich Eysholdt
  • Franco Fussi
  • Ahmed Geneid
  • Tamás Hacki
  • Katarzyna Karmelita-Katulska
  • Renate Haubrich
  • František Šram
  • Jan G. švec
  • Jitka Vydrová
  • Bożena Wiskirska-Woźnica
Part of the European Manual of Medicine book series (EUROMANUAL)


Basic information for diagnosis and differential diagnosis of voice disorders is drawn from medical history (the nature of the change in the sound of the voice, pitch, extent and loudness of voice, frequently reported hoarseness and its severity, any occurrence of episodes of voice loss, fatigability of voice) and auditory evaluation (mean speaking pitch, voice onset, pitch range, capability of increasing loudness, perceptual scale of the sound of the voice including nasality, stability). Self-administered questionnaires have proven to be important instruments for the evaluation of the impact of a voice problem on the quality of life of patients. Objective data are available from acoustic analyses (phonetography [voice range profile], visible speech [spectrography], quantification of Fo, voicing %, perturbation parameters, harmonics-to-noise ratio, etc.) and from aerodynamic measurements (maximum phonation time, body plethysmography). In addition to the classic assessment of the laryngeal structures by means of laryngoscopy, stroboscopy is a widely used standard as a subjective tool for the visualisation of vocal fold vibration. Among objective approaches, videokymography is increasingly being used, and high-speed video with consecutive vibrogram display and electroglottography are other options. Vibrational analyses are particularly useful for the detection of beginning malignomas and hidden lesions. They may be also helpful for the evaluation of the vibrating lips within the practice of musician’s medicine for assessing the occupational (in)capacity of professional brass musicians. Electromyography (EMG) is indicated for vocal fold immobility of unknown origin to distinguish paralysis from mechanical fixation. Ultrasound sonography may concern spoken articulation as well as phonation. Proposals for voice loading tests, because of the complexity of the issue, need further improvement and standardisation.


Diagnostics Auditory assessment Acoustic analyses Aerodynamic measures Laryngoscopy Stroboscopy Videokymography High-speed video Vibrogram Electroglottography Electromyography Sonography Loading tests Brass musicians 

Supplementary material

Video 6.1

Tips and tricks for laryngeal examination. Video performed by: Tiina Pakka, Annika Laaksonen and Ahmed Geneid (MP4 115356 kb)

307062_1_En_6_MOESM2_ESM.wmv (14.2 mb)
Video 6.2 Stroboscopy of the lips: crescendo-decrescendo, French horn. Regular vibratory pattern of the lips (WMV 14521 kb)
Video 6.3

Stroboscopy of the lips: musical scale, trumpet. Regular vibratory pattern of the lips (MP4 11202 kb)

Case Study Video 6.4

Stroboscopy of the lips: flugelhorn player with stenosis of the spinal canal between C2 AND C5 (MP4 21016 kb)

Video 6.4

Stroboscopy of the lips: single tones played with the trombone. The regular vibratory pattern of the lips is similar to the vocal fold vibration. The mucosa in the centre of the upper lip initiates the closure as a result of the Bernoulli effect (MP4 13012 kb)

Video 6.5

Sonography of the lips: transversal b-mode scans of the upper lip. Orbicularis oris muscle visible as narrow black band (MP4 3231 kb)

Video 6.6

Sonography of the lips: sagittal B-mode scans of the lips (upper lip left, lower lip right, cavum oris in between). Typical ‘hockey stick’ shape of the orbicularis oris muscle, visible as black band within the lip (MP4 4559 kb)

Video 6.7

Kymography (high-speed line scanning) of the lips: broken chords, French horn (upper lip right, lower lip left) (MP4 13779 kb)

Video 6.8

Kymography (high-speed line scanning) of the lips: sound of tuba played at Gflat0 (23 Hz). Because of this low frequency, the tone is hardly audible. The real-time video kymogram shows approximately one vibrational cycle per image. Solely the upper lip is visible from the right (MP4 4276 kb)

Video 6.9

Sonography of the tongue: mediosagittal scans (left) and simultaneous TM-mode scans (right) while playing the soprano recorder (MP4 6203 kb)

Video 6.10

Sonography of the tongue: mediosagittal scans (left) and simultaneous TM-mode scans (right) during trumpet playing (MP4 4531 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Wolfgang Angerstein
    • 1
    Email author
  • Giovanna Baracca
    • 2
  • Philippe Dejonckere
    • 3
  • Matthias Echternach
    • 4
  • Ulrich Eysholdt
    • 5
  • Franco Fussi
    • 6
  • Ahmed Geneid
    • 7
  • Tamás Hacki
    • 8
  • Katarzyna Karmelita-Katulska
    • 9
  • Renate Haubrich
    • 10
  • František Šram
    • 11
  • Jan G. švec
    • 12
  • Jitka Vydrová
    • 11
  • Bożena Wiskirska-Woźnica
    • 13
  1. 1.Phoniatrie und PädaudiologieUniv.-Klinikum DüsseldorfDüsseldorfGermany
  2. 2.ENT DepartmentAO Niguarda Cà GrandaMilanItaly
  3. 3.Federal Agency for Occupational RisksBrusselsBelgium
  4. 4.Department of Otorhinolaryngology, Division of Phoniatrics and Pediatric AudiologyMunich University Hospital (LMU), Campus GroßhadernMunichGermany
  5. 5.Department of Medical Physics and Acoustics/Medical Physics and Cluster of Excellence Hearing4allCarl von Ossietzky-Universität OldenburgOldenburgGermany
  6. 6.AudioPhoniatric Centre, Azienda USL RomagnaRavennaItaly
  7. 7.Department of Otolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University Central HospitalHelsinkiFinland
  8. 8.Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University BudapestBudapestHungary
  9. 9.Department of NeuroradiologyUniversity of Medical Sciences in PoznanPoznanPoland
  10. 10.Evangelisches Klinikum Niederrhein Duisburg-Nord, Zentrale Abteilung für Diagnostische und Interventionelle RadiologieDuisburgGermany
  11. 11.Voice and Hearing Centre PraguePrague 2Czech Republic
  12. 12.Department of Biophysics, Faculty of SciencePalacky UniversityOlomoucCzech Republic
  13. 13.Department of Phoniatrics and AudiologyPoznan University of Medical SciencesPoznanPoland

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