Related Experiment Video
Updated: Jul 19, 2026

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis (ALS)
Published on: February 21, 2011
Perceptual voice analysis of patients with subglottic stenosis
Sandra L Ettema1, Carol Jorgensen Tolejano, Robert J Thielke
1Division of Laryngology, Department of Otolaryngology and Communication Sciences, Surgical Services, Zablocki VAMC, Milwaukee, Wisconsin, USA.
Objectives:
To characterize the perceptual assessment of vocal quality in subglottic stenosis (SGS) patients and to identify risk factors for dysphonia.
Study Design And Setting:
Retrospective review, academic center.
Methods:
Perceptual voice assessment using GRBAS scale (Grade, Roughness, Breathiness, Asthenia, Strain); patient characteristics determined for 31 SGS cases.
Results:
The mean GRBAS (0 to 3 scale, 0 = normal quality) for SGS patients at their initial visit was G(1.4)R(1.2)B(0.5)A(0.5)S(1.1). For males vs females: G(2.1 vs 1.1)R(2.0 vs 0.8)B(1.0 vs 0.4)A(1.0 vs 0.3)S(1.7 vs 0.9). The Grade (P < 0.03), Breathiness (P < 0.04), and Asthenia (P < 0.02) assessments were significantly more dysphonic in patients with multilevel stenosis; vocal fold motion impairment (VFMI) also impacted overall Grade (P < 0.01). Overall Grade (P < 0.002), Roughness (P < 0.007), and Breathiness (P < 0.006) were significantly worse in patients with prior airway surgery.
Conclusion:
SGS patients demonstrate a mild to moderate change in perceptual voice characteristics with males in this series being more affected than females. Negative risk factors include multiple stenoses, VFMI, and previous airway surgery.
Significance:
This is the first systematic report of perceptual voice assessment in subglottic stenosis. SGS patients have notable degrees of dysphonia with identifiable risk factors.
Related Concept Videos
Physical Assessment of the Respiratory Tract IV: Auscultation
Breath Sounds
Breath sounds are categorized into vesicular, bronchovesicular, and bronchial.
Respiratory System Abnormal Finding II: Palpation and Auscultation
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities:
Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...
Larynx
Anatomy of the Larynx
The larynx consists of various components, including cartilage, muscles, and vocal cords. Its structure includes three large unpaired cartilages—the thyroid, cricoid, and epiglottis—and three smaller paired cartilages—the arytenoids, corniculates, and...
Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...

