Pattern recognition in muscle misuse voice disorders: how I do it.

The diagnosis of the patient with a muscle misuse voice disorder can be a complex process. The dysphonia is usually caused by problems stemming from a number of interacting factors that may include habitual vocal technique and postural use, vocal behavior, emotion, manifestations of gastroesophageal reflux, neuromuscular abnormalities, and associated organic mucosal disease. Sorting out the relative importance of the various factors is the first step towards planning an effective treatment program. This article addresses the difficulties caused by trying to classify dysphonia too rigidly, and presents a strategy for collecting the necessary information in a manner that facilitates the development of effective tools for clinical decision making. For each dysphonic patient, a pattern of causation will emerge in a way that helps the clinician to disentangle the interrelated factors.