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What are Voice Disorders and Who Gets Them??

What are Voice Disorders and Who Gets Them??
James A. Koufman, MD
June 9, 2003


A voice disorder may prevent a professional singer from performing or a business person from effectively managing his or her affairs, or it may prohibit simple, daily, verbal communication between elderly spouses. A person's vocal quality may influence the type of work that person does, and conversely, the type of work a person does may influence the importance of avoiding voice difficulties and the degree of professional impairment that may result from a voice disorder.

Voice disorders are ubiquitous, and many have severe social, psychological, professional, and economic consequences. Until relatively recently, many voice disorder patients went untreated, but today, with advances in diagnosis and treatment, that has all been changed. The purpose of this article is to convey to the reader a sense of who gets voice disorders, the relative frequency of the different types of voice disorders, and the factors that cause voice disorders.

Levels of Vocal Usage

The success of treating patients with voice disorders depends, to a great extent, upon the voice clinician's identification of the ''vocal needs'' of each patient within the context of that patient's professional and social needs and obligations. The same voice disorder may have a profoundly different impact on two different patients depending upon the patient's profession or ''level of vocal usage.'' The Center for Voice Disorders of Wake Forest University, has identified four levels of vocal usage.

  • The Elite Vocal Performer, Level I, is a person for whom even a slight aberration of voice may have dire consequences. Most singers and actors are in this group; the opera singer is the quintessential level I performer.

  • The Professional Voice User, Level II, is a person for whom a moderate vocal problem might prevent adequate job performance. This group includes most clergy, teachers, lecturers, receptionists, etc.

  • The Non-Vocal Professional, Level III, is a person for whom a severe vocal problem would prevent adequate job performance. This group includes lawyers, physicians, businessmen, business women, etc.

  • The Non-Vocal Non-Professional, Level IV, is a person for whom vocal quality is not a prerequisite for adequate job performance. This group includes clerks, laborers, and so forth. Although persons in this group may suffer very significant social liability from a voice disorder, they are not prevented from doing their work.

While this classification of levels of vocal usage is helpful in examining the question of who gets voice disorders, it does not have any implications for the overall social and psychological impact of impaired communication that may be suffered by any person with a voice disorder.


James A. Koufman, MD

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