The Voice Examination
Examination of the voice begins with a complete ear, nose, and throat examination, followed by dedicated examination of hte larynx and vocal folds. 

The Ear, Nose and Throat Examination:
Examination of the entire ear, nose, throat,
head and neck region
Assessment of hearing function with a tuning fork, and if indicated, a formal hearing test (audiogram)
Philadelphia Voice Center
Professional Voice Care, Otolaryngology-Head and Neck Surgery
Laryngeal examination
After the head and neck are examined, a detailed assessment of the larynx is usually performed

  • Evaluation of the larynx usually involves evaluation of the movement of the vocal folds during speech, singing, and the other tasks, and evaluation of the vibratory function of the folds

  • Vocal fold movement is usually best assessed with a flexible, fiberoptic laryngoscope

  • Assessment of vocal fold vibration is usually assessed with stroboscopic light, using either a flexible laryngoscope, a rigid laryngoscope, or both

What is a Flexible Laryngoscopic Examination?

  • A flexible laryngoscope is a thin, lighted telescope (endoscope) that is placed through the nose and into the throat

  • The patient is seated and awake during the examination

  • The flexible laryngoscope allows the physician to see the larynx in its natural position, without the distortion that sometimes occurs with holding the tongue forward for mirror and rigid telescopic examinations

  • In viewing the larynx in its natural position, the physician can assess changes in the laryngeal muscle tension while the patient is talking or singing

  • There are certain vocal maneuvers that the otolaryngologist/laryngologist will ask the patient to perform during the flexible laryngoscopic examination, these include various tasks of talking, singing, and whistling

  • While the patient is performing these maneuver, the laryngologist is evaluating the motion and mobility of the vocal folds

  • The patient will be asked to perform several tasks that require stretching and lengthening the vocal folds

What is Rigid Strobovideolaryngscopy?

  • Rigid strobovideolaryngoscopy allows a more magnified and optically superior view of the vibratory function and structure of the vocal folds.

  • Strobovideolaryngoscopy involves the use of synchronized flashing lights through the telescope to evaluate the function of the mucosal wave of the vocal fold

  • This procedure is performed with a rigid telescope placed through the mouth with the tongue held forward, the patient is awake and seated in a forward position during the examination, the chin is held slightly upright in a “sniffing” position, which helps to pull the base of the tongue forward so that the larynx can be viewed easily

  • This magnified view of the vocal folds can give the physician information regarding structural lesions on the vocal folds that may contribute to the vocal complaint or that have arisen as a result of the paresis

What is Laryngeal Electromyography?

  • Laryngeal electromyography (LEMG) is a procedure that evaluates the integrity of the muscular and nervous systems of the larynx.

  • This test is performed on patients who have evidence of a movement disorder of the vocal folds

  • The purpose of LEMG is to help the physician diagnose and differentiate the causes of these movement disorders: These can be classified as disorders in movements of the joints that connect the cartilages of the larynx, primary problems within the muscles themselves, or problems in the nerves that supply the muscles of the larynx

  • Understanding the exact mechanism of the problem is important in helping the physician understand how to best treat the patient’s voice problem and in helping speech-language pathologists and singing voice therapists select the best exercises to help rehabilitate the voice

  • The information gained from the LEMG helps in the differentiation and diagnosis of disorders in nerve, muscle, and joint function.

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