Phonogram - identifying a voice disorder
Channel: VOXDOC - the voicedoctor
Date: 2020-03-24

This video answers the question: Why should an examiner (laryngologist, phoniatrist, speech therapist, voice teacher) listen to the voice?

Seeing sound. Many specialists are visual people. Physicians often enter into a surgical speciality for their talent to see something and remove it, yet, for voice disorders, their ear isn’t well trained. Maybe they can’t carry a tune, but specialize in laryngology anyway. 

If I am a patient who is hoarse, my complaint is about sound. Sound is created by the movement of air and if one can’t see air, how does one visualize sound?

Often an examiner says the larynx looks normal. I find that patients may be more accurate about their perception that something is not clear in their voice than physicians are at recognizing what is impaired. While the task of identifying the impairment is more difficult than just hearing it, diagnosticians all too often hide (perhaps unconsciously) their knowledge deficit. A “normal” appearing larynx ends up being “treated” by prescribing a pill or speech therapy rather than admiting the need for a more directed examination. 

Patterns. Training your ear a little bit, we can begin to recognize regular and irregular air flow. Listening to a range of pitch and volume patterns of hoarseness appear. We can convert these findings into a phonogram, a graphic profile representing a vocal signature. Seeing a vocal signature improves understanding of vibration disorders and laryngeal compensation, leading an ear-trained diagnostician to an accurate perception of the vocal cord vibratory impairment before looking with an endoscope and stroboscope.Ultimately, this phonogram identifying hoarseness translates visually into pathology using endoscopy and stroboscopy. Gradually it can become possible, even easy, to identify voice disorders by ear alone.