Diagnosis of Voice Disorder
Diagnosis of voice disorders is a complex, specialist undertaking and should be carried out by the multidisciplinary team.

The use of GRBAS, and Praat computerised assessment of voice features is discussed here as Speech and Language Therapists may undertake these as part of their initial assessment.

If the Speech and Language Therapist is not directly working alongside an Ear, Nose and Throat (ENT) Doctor or Consultant, then a referral should be made so further assessment may be undertaken. This is especially important to arrive at a correct diagnosis, and to ensure that Service Users are able to undertake further speech and language therapy safely, such as Voice and Communication Therapy (VCT).

Some Speech and Language Therapists have an extended role and may undertake specialist assessments in voice disorder.
Tools for the subjective assessment of voice
A range of tools should be used by the clinician to gain as much information as possible to inform diagnosis, onward referral/joint assessment with the multi-disciplinary team, and possible therapy.

This is covered by Omori (2011), including:
  • Medical case history
  • Inspection and palpation
  • Maximum phonation time
  • Auditory-perceptual evaluation of hoarseness, such as the GRBAS scale

In the UK, some Speech and Language Therapists may undertake specialist Otorhinolaryngological Tests, or these may be carried out by an Ear, Nose and Throat Consultant, or a joint voice clinic, when're both ENT and SLTs work together.

Subjective assessment of the voice is an important aspect of data collection. The assessment usually covers clinician and Service User evaluations of voice.

Clinicians may use a framework called GRBAS.

    • The overall grade of hoarseness or abnormality
    • Harshness / abrasiveness / irregularity of vocal fold vibrations
    • Air leakage through the glottis
    • Weakness or lack of power
    • Tightness / hyper functional state of phonation


  • 0, 1, 2, or 3
  • 0 is normal
  • 1 is a slight degree
  • 2 is a medium degree
  • 3 is a high degree.

Training to use GRBAS ratings
Walden, P. R. (2020). The Perceptual Voice Qualities Database (PVQD). Mendeley Data. https://data.mendeley.com/datasets/9dz247gnyb/3

The is a database which students and clinicians may download, containing voice pathology recordings and comprehensive ratings. This makes it an ideal CPD tool for those working with vocal pathology.


Omori, K. (2011). Diagnosis of Voice Disorders. Journal of the Japan Medical Association, 54(4), 248-253. https://www.med.or.jp/english/journal/pdf/2011_04/248_253.pdf

Yamauchi, E. J., Imaizumi, S., Maruyama, H., & Haji, T. (2010). Perceptual evaluation of pathological voice quality: A comparative analysis between the RASATI and GRBASI scales. Logopedics Phoniatrics Vocology, 35(3), 121-128. https://doi.org/10.3109/14015430903334269

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