Voice examination is a crucial diagnostic tool for assessing conditions related to the respiratory system, nervous system, and ENT disorders. A structured and systematic approach ensures accurate diagnosis and effective management.
I. Steps in Shabda Pariksha (Voice Examination)
The examination of voice includes history-taking, physical examination, instrumental assessment, and special tests.
1. History Taking (Purva Pariksha)
A detailed history is essential to understand the onset, duration, and associated symptoms of voice changes.
✔️ Onset – Sudden (stroke, nerve damage) or gradual (hypothyroidism, nodules)?
✔️ Duration – Temporary (laryngitis) or persistent (vocal cord paralysis, tumors)?
✔️ Character of Voice Change
- Hoarseness
- Breathiness
- Nasal tone
- Weakness or tremor
✔️ Associated Symptoms - Throat pain
- Difficulty swallowing
- Dryness or excessive mucus
✔️ Occupational & Lifestyle Factors - Overuse (teachers, singers, call center workers)
- Smoking or alcohol
- Acid reflux history
✔️ Neurological Symptoms - Slurred speech
- Muscle weakness
- Fatigue
2. Physical Examination (Darshana, Sparshana, & Prashna Pariksha)
A complete head & neck, ENT, and neurological examination helps in localizing the cause of voice disorders.
✅ General Observation
- Listen to the patient’s normal conversational voice.
- Ask the patient to speak at different pitches and volumes.
✅ Palpation of the Larynx & Neck
- Check for laryngeal tenderness, masses, thyroid enlargement, or nerve dysfunction.
✅ Respiratory Assessment
- Evaluate breathing pattern, shortness of breath, or stridor (high-pitched wheezing).
✅ Oral Cavity & Pharynx Examination
- Look for signs of infection, swelling, ulcers, or postnasal drip.
✅ Neurological Examination
- Cranial nerve testing (especially CN IX, X, and XII).
- Assess tongue movement, gag reflex, and vocal cord symmetry.
3. Instrumental & Advanced Examination
If needed, specialized diagnostic tools and imaging help confirm findings.
| Test | Purpose |
|---|---|
| Indirect Laryngoscopy | Visualizes the vocal cords & movement |
| Flexible Fiberoptic Laryngoscopy | Detects polyps, nodules, or vocal cord paralysis |
| Videostroboscopy | Assesses vocal cord vibration in detail |
| Electromyography (EMG) | Evaluates neuromuscular function of laryngeal muscles |
| Acoustic Voice Analysis | Measures pitch, intensity, and irregularities in voice |
| CT/MRI of Neck & Brain | For tumors, neurological causes, or anatomical abnormalities |
II. Special Voice Tests for Clinical Diagnosis
A series of simple tests can help identify specific voice disorders.
| Test Name | Procedure | Interpretation |
|---|---|---|
| Cough Test | Ask the patient to cough | Weak cough → Vocal cord paralysis |
| Sustained Phonation | Ask the patient to say “Ahh” as long as possible | Short duration → Weak lung or vocal cord function |
| Nasality Test | Ask patient to say “M” or “N” | Hypernasality → Palatal weakness |
| Pitch Glide Test | Ask the patient to sing from low to high pitch | Limited range → Vocal cord stiffness |
| Tremor Test | Observe tremor in sustained phonation | Tremor → Parkinson’s, neurological disorder |
III. Differential Diagnosis Based on Voice Findings
By analyzing the nature of voice changes, we can classify possible causes:
| Voice Characteristic | Possible Diagnosis |
|---|---|
| Hoarseness | Laryngitis, vocal cord nodules, GERD, hypothyroidism |
| Breathy Voice | Vocal cord paralysis, myasthenia gravis |
| Strained or Effortful Voice | Spasmodic dysphonia, neurological disorder |
| Weak or Monotonous Voice | Parkinson’s disease, motor neuron disease |
| Hypernasality | Palatal weakness (stroke, myasthenia gravis) |
| Hyponasality | Chronic sinusitis, nasal polyps |
IV. Ayurvedic Perspective & Diagnosis
In Ayurveda, voice changes are classified based on dosha imbalances affecting speech production.
| Dosha Involvement | Voice Features | Possible Conditions |
|---|---|---|
| Vata Imbalance | Weak, irregular, dry, tremulous voice | Neurological disorders, stress, aging |
| Pitta Imbalance | High-pitched, harsh, burning sensation | GERD, throat infections, inflammation |
| Kapha Imbalance | Thick, heavy, nasal voice, mucus-laden | Chronic sinusitis, congestion, hypothyroidism |
🔹 Examination Method in Ayurveda
✔️ Prakriti & Vikriti Analysis – Identifying constitutional voice characteristics.
✔️ Nadi Pariksha – Identifying underlying dosha imbalances affecting vocal function.
✔️ Shabda Swaroopa (Sound Quality Examination) – Evaluating the voice’s clarity, strength, and pitch.