Voice Rating

The voice rating is used to describe on a comparative basis the voice as it affects the clinician (or other listeners).

A rating of "1" means the problem is barely perceptible.

A rating of "7" means the problem significantly interferes with communication.

The judgement has an effect on the decision to provide intervention and on determining progress during intervention.

Laryngeal Cavity

The horizontal line deals with the position of the VF during phonation
 

This evaluation is based on a continuum from a hypofunctional state (-4) to a hyperfunctional state (+3).

At the extreme left of the continuum, -4, the VF are totally abducted, the vocal chink is nonrestricted, and the individual produces little, if any, voicing, i.e. he/she is totally aphonic.

Moving from left to right, -3 , equates to a narrowing of the vocal chink and the production of a whisper; there is little medial compression of the vocal folds during the adducted stage.  This voice is characterized by considerable friction.  This is the voice type of hysterical or functional aphonia.

A rating of -2 represents breathiness of the voice.  This voice is characterized by turbulence, friction and a drop or reduction in loudness.

 Normal laryngeal cavity is the 1 or center point of the horizontal and vertical lines.

A rating of +2 represents a voice that is characterized by marked tension.  Voicing is maintained but the perception of the voice by listeners is one of vocal strain.  There is generally an increase in vocal loudness.

A rating of +3 represents the closed or hyperfunctional larynx.  The VF are in high tension during attempted voicing.  The tension and over adduction is sufficient to stop phonation at least periodically.  That is there are random closure patterns of the VF with an inability to sustain phonation.  This results is a strained-strangled voice quality and is represented in patients with spasmodic dysphonia (adductor type)

The vertical line represents the pitch of the voice.
 

A rating of 1 represents a pitch that is appropriate for the sex of the person producing the voice

The extremes (+3 and -3) represent those pitches which are sufficiently deviant to cause the individual to lose sexual identity if that judgement is made on an acoustic basis only. Therefore +3 represents a voice whose pitch is too high and gives the impression of a female voice in a male client.  Conversely, -3 represents a voice whose pitch is too low and gives the impression of a male voice in a female client.

Ratings of -2 and +2 represent deviations of pitch that cause concern primarily to a critical listener, usually an SLP.  These rarely cause the client social anxiety or result in changes in sex characteristics of the voice.

The vertical line represents velopharyngeal competency.

A rating of +4 represents a voice in which there is hypernasality on all vowels with nasal air emission on consonants

A rating of +3 is a indication that there is nasalization of hypernasality of all vowels with some shading of nasality to the consonants

A rating of +2 designates hypernasality confined to assimilated nasality on some vowels

A rating of 1 is an indication of a balance between nasality and orality or appropriate resonance

A rating of -2 represents a voice that is lacking in nasal resonance in the production of normally nasalized sounds (denasality)

Intensity and Vocal Range

• These are considered descriptive dimensions and are not considered primary components of the voice.

• Identify if these are variable or constant over time and under differing conditions.