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A screening assessment of voice, resonance, and articulation: a guide for the otolaryngologist

Disorders of voice, resonance, or articulation can affect the quality and clarity of expressive communication, making speech distracting to the listener or difficult to understand. These types of communication disorders can have a negative impact on the patient's social interactions, interpersonal relationships, and job opportunities. Although a communication disorder is not life threatening, it is life altering and has a significant effect on the quality of life. Primary care physicians and patients often consult an otolaryngologist regarding disorders of voice, resonance, or articulation. The assumptions are that the problem is due to either faulty hearing or the result of a structural abnormality of the oral cavity or vocal tract. Although the otolaryngologist has expertise in assessing anatomic and physiologic abnormalities of the ear, nose, mouth, and throat, this specialist may have difficulty assessing the functional correlates to the abnormalities found. When no obvious abnormalities are discovered, the cause and appropriate treatment of the speech symptoms may be especially difficult for the physician to determine. This paper is an overview of how to informally evaluate voice, resonance, and articulation disorders in order to make a judgment as to appropriate course of treatment or the need to refer to a speech-language pathologist for further evaluation.