The following outline covers the major areas of thought during a review of the history. I use this form to gather information from a patient. (History - pdf version)

• Onset

  Usually the patient thinks the exacerbation is the onset. Careful probing will often reveal a much longer duration of illness

• Obvious Causes

  Events that were synchronous with or preceeded the onset of the voice problem.

• Symptom Complexes

  A pattern of symptoms develops because every disease is necessarily complex. In particular since the larynx plays a role in swallowing, breathing and speaking, a single change in structure or functional capacity will likely affect multiple symptoms. During the history then, if a few symptoms suggest a particular voice disorder, further questioning can probe for other symptoms that should be present in that particular complex. Later in this essay various symptom complexes are defined.

• Perception of severity/motivation

  This answers the question «Does the patient want only an explanation or do they actually want some intervention?» Because you can do surgery doesn’t necessarily mean that you should. It may also supply clues that support the diagnosis of nonorganic disorders.

• Previous treatments & Diagnosis

  If the patient has already received an opinion or a treatment from another otolaryngologist, speech therapist or any medical provider.

• Need to speak

  • innate talkativeness
  • extrinsic drive to speak

• Risk factors

  • Tobacco
  • Alcohol
  • Fluids
  • Reflux or heartburn
  • caffeine
  • medications
  • other medical problems