Sorting out the causes of dysphonia in a person seeking help with a difficult voice disorder can be a complex challenge. Often a number of interrelated factors are involved in the etiology, and if one jumps to conclusions too quickly about an apparently obvious diagnosis the real aspects that require treatment may be missed. The model presented here is designed to help the clinician work through a difficult voice evaluation and come up with a truly helpful treatment plan. But first, a few concepts or presuppositions that have been presented in more detail elsewhere.
Voice production is an athletic skill requiring coordination of muscle systems throughout the body.
A column of air under relatively low pressure must flow upwards past vocal folds that are held in adduction with a force appropriate to the task. The upper vocal tract resonators are adjusted to provide amplification and the desired tonal focus. Some individuals are naturally skillful vocal athletes, most are average, and a few are quite lacking in vocal technical ability. The levels of skill tend to follow a normal distribution curve such as shown here. Voicing with poor technique, which we term voice misuse, will lead to more wear and tear on the vocal folds than will the same level of voice abuse produced with skill.