Clinical Panorama in The Voice Area: Lessons Learned by Scientific Development

Scientific development has completely changed the clinical scenario in the voice area. An evident transformation from an intuitive and abstract approach occurred in the last decades. The international presence is evident in the voice specialty particularly since many approaches can be used worldwide, regardless the spoken language. There are many cultural particularities in the expression of dysphonia and in the type of service delivery, however, there is a clear common ground that expresses the recent evolution in the area. The goal of this presentation is to explore 5 topics in the light of the literature: 1. Normalcy of larynx and voice: there is an impressive variability on the presentation of a normal larynx in individuals with normal voices so, the laryngeal configuration per se may not be robust enough to take decision in many cases; on the other hand, other hand, voice is not a binary descriptor (normal X abnormal) but a measure (like weight and height), a tendency and there are many cultural influences on the perceptual auditory analysis of a sample; moreover, the phonetic context may interfere at the perceptual judgement; 2. The clinical speech-language pathologist evaluation: a multidimensional and multiparametric approach should be used, even if the perceptual assessment is the gold standard for assessing vocal quality; subjective and objective parameters contribute to document the patient, as well as a self-assessment on the impact of a voice problem; correlation among all dimensions is not perfect but has to be understood; 3. The patient perspective: the experience of living with a voice problem has to be evaluated and cannot be estimated by any other clinical measure; the clinician needs to select the most indicated protocol for the case; 4. The core of vocal rehabilitation: voice therapy is a non-linear process that combines direct and indirect approaches and there is good evidence on the effect of this intervention, regardless the method used; and 5. Behavioral X Organic Dysphonia; behavioral cases usually are a real challenge for rehabilitation and may be linked to self-regulation coping and adherence aspects; on the other hand, organic cases are not related to the vocal behavior and the patients presentation is different as well as the clinical management. A variety of cases will be presented and discussed.