Koufman and Blalock classified functional voice disorders based on clinical features. The authors are from Wake Forest University in Winston-Salem, North Carolina.
Parameters:
(1) onset
(2) history
(3) voice quality
(4) exam (indirect laryngoscopy, other)
|
Parameter |
Hysterical Aphonia or Dysphonia |
Habituated Hoarseness |
|
Onset |
acute, sudden |
long-standing |
|
History |
often precipitating event, no history of laryngitis |
onset after acute episode of laryngitis; variable evidence of "secondary gain" |
|
Voice Quality |
aphonia or whisper; pitch-locked if any voice; stable (does not fluctuate) |
breathy, raspy, diplophonia; pitch-locked; stable (does not fluctuate) |
|
Exam |
normal |
usually normal, occasional plica ventricularis |
|
Parameter |
Falsetto |
Voice Abuse |
|
Onset |
life-long of sudden |
long-standing |
|
History |
NA |
overuse; pitching the voice too low; tensing muscles in larynx and neck |
|
Voice Quality |
abnormally high-pitched; pitch-locked; stable (does not fluctuate) |
variable dysphonia; hard glottal attack; not pitch-locked; intermittent or may fluctuate; throat pain |
|
Exam |
normal |
normal or vocal nodules or polyps or ulcers or granulomas |
where:
• The authors also referred to the voice abuse category as the Tension-Fatigue Syndrome (TFS).
|
Parameter |
Postoperative |
|
Onset |
gradual |
|
History |
vocal abuse following surgery |
|
Voice Quality |
dysphonia; hard glottal attack; not pitch-locked; may have pain |
|
Exam |
normal or mucosal ulcers or plica ventricularis or granulomas |
Specialty: Pulmonology
