Physical exam

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I include a general ear, nose and throat examination for a few reasons. Many of the structures and nerve of the region are related. Perhaps the most well know example is otalgia or ear pain where the sensory nerve within the ear and within the larynx reach the same location in the brain. 

The neurology of cranial nerves VII through XII is densly compact centrally and thus related to voice. The structures of the pharynx, mouth and nose alter resonance. Malignant tumors of the larynx spread into the neck. 

Additionally, in the US, insurance companies do not recognize an examination of the voice. Their reviewers are only trained to recongize content for a general ENT examination. If the physician does not get enough points on the general ENT examination, the bill is not paid no matter how thorough the laryngeal and voice examination.

Physical examination form

This is a guide for areas I typically attend to during an examination.

Voice physical examination form utilized by James Thomas

Vocal committments 

This is really a part of the history. I have placed it on the back of my intake form because I have patients fill out the front and this part seems to be difficult for individuals to fill out without additional explanation. Vocal committments refer to how much time the individual devotes to singing. I assess how much they sing on their own as well as performance time and type.

ENT exam 

ENT exam is a general overview of the head and neck region.

Laryngeal Acoustic Testing - Vocal Capabilities

I elicit a battery of vocal tasks and record them. These are described in a subsequent chapter on Vocal Capabilities. Usually I will have a focused differential diagnosis after this point in the exam. I tend to write down my impression at this point in the exam to learn how accurate my ear is in predicting a pathology.

Endoscopy & stroboscopy

I use the information obtained in the history and during the vocal capabilities assessment to focus my endoscopy on the likely area of vocal pathology.

In a subsequent chapter, I discuss options for endoscopically examining vocal cord structure and function.