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Phoniatricians usually have the key role when dealing with a voice disorder, supported by logopedists/speech-language pathologists. Cooperation with other medical or non-medical disciplines may contribute when needed. Fundamentals, general goals and the structure of voice therapy are followed by a survey of specific methods and techniques. No matter what kind of technique is used, treatment strategy is inevitably based on pathophysiological mechanisms of a disorder and the patient’s state as a whole. Voice therapy is a dynamic process and not an application procedure for a stable phonatory pattern or a list of exercises for every patient. This integrative model for treatment of voice disorders includes additional skills and knowledge of mechanisms of applications, stages of behavioural treatment, phases of motor learning, stages of voice therapy and steps of a given technique. Functional disorders of the singing voice (dysodia) require additional and specific expertise, especially in emergency situations in the frame of cancellation policy regarding the opera and theatre business. Drug treatment and physiotherapy/osteopathy as more therapeutic approaches to voice disorders are presented, as well as phonosurgical procedures, i.e. functional surgical interventions aiming exclusively, or in part, at improvement, restoration or preservation of vocal function. Methods comprise of phonomicrosurgery (endoscopic microsurgery), laryngeal injection and laryngeal framework surgery that modify the cartilaginous framework of the larynx (laryngoplastic phonosurgery, open-neck surgery). Pacing and reinnervation are also discussed as alternatives in bilateral vocal fold palsies, and vocal rehabilitation after head and neck surgery, including the use of personalised computer speech synthesis for laryngectomised patients, is considered. Indications for tracheostomy and tracheostoma care refer to clinical practice. The prognosis of voice rehabilitation depends on the various factors that are included in voice production and should be considered accordingly.

Basic information for diagnosis and differential diagnosis of voice disorders is drawn from medical history (the nature of the change in the sound of the voice, pitch, extent and loudness of voice, frequently reported hoarseness and its severity, any occurrence of episodes of voice loss, fatigability of voice) and auditory evaluation (mean speaking pitch, voice onset, pitch range, capability of increasing loudness, perceptual scale of the sound of the voice including nasality, stability). Self-administered questionnaires have proven to be important instruments for the evaluation of the impact of a voice problem on the quality of life of patients. Objective data are available from acoustic analyses (phonetography [voice range profile], visible speech [spectrography], quantification of Fo, voicing %, perturbation parameters, harmonics-to-noise ratio, etc.) and from aerodynamic measurements (maximum phonation time, body plethysmography). In addition to the classic assessment of the laryngeal structures by means of laryngoscopy, stroboscopy is a widely used standard as a subjective tool for the visualisation of vocal fold vibration. Among objective approaches, videokymography is increasingly being used, and high-speed video with consecutive vibrogram display and electroglottography are other options. Vibrational analyses are particularly useful for the detection of beginning malignomas and hidden lesions. They may be also helpful for the evaluation of the vibrating lips within the practice of musician’s medicine for assessing the occupational (in)capacity of professional brass musicians. Electromyography (EMG) is indicated for vocal fold immobility of unknown origin to distinguish paralysis from mechanical fixation. Ultrasound sonography may concern spoken articulation as well as phonation. Proposals for voice loading tests, because of the complexity of the issue, need further improvement and standardisation.

The chapter reflects the main clinical manifestations of voice disorders, the wide diversity and multiple sociocultural interrelations of which contrast with a consistent systematic order of aetiological or symptomatic categories. Instead, the compilation follows prevailing purposes to provide a useful overview for application in everyday practice. Functional dysphonias, psychosomatic voice dysfunction and singing voice disorders are closely related to each other but nevertheless require individual consideration regarding special diagnostic procedures as well as therapeutic or rehabilitative consequences, including occupational perspectives. Organic manifestations comprise benign lesions of the mucosa of the vocal folds, gastro-oesophageal reflux influences, central and peripheral neurogenic disorders and laryngeal sensory neuropathy. A section on hormone-related dysphonias is followed by a survey on gender vocology focused on the demands of male-to-female as well as female-to-male adaptation of transsexuals. Voice disorders in systematic diseases and also as consequences of environmental influences and allergy complete the chapter that includes paying attention to special aspects of the voices in childhood and adolescence and the elderly population. Malign lesions are not part of this chapter.