The Language We Use in Clinical Voice I have substantive concerns about some of the clinical language that we use in voice disorders. I presented on the topic generally at the 1997 Pacific Voice Conference and was asked to write about one specific pair of terms for the Division 3 Newsletter: the terms vocal abuse and misuse. ... Article
Article  |   August 01, 1998
The Language We Use in Clinical Voice
Author Affiliations & Notes
  • Katherine Verdolini
    Otology and Laryngology, Harvard Medical School, Boston, MA
    Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
    Voice and Speech Lab, Massachusetts Eye and Ear Infirmary Voice/Speech/Swallowing Division, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA
Article Information
Article
Article   |   August 01, 1998
The Language We Use in Clinical Voice
SIG 3 Perspectives on Voice and Voice Disorders, August 1998, Vol. 8, 3-4. doi:10.1044/vvd8.2.3
SIG 3 Perspectives on Voice and Voice Disorders, August 1998, Vol. 8, 3-4. doi:10.1044/vvd8.2.3
I have substantive concerns about some of the clinical language that we use in voice disorders. I presented on the topic generally at the 1997 Pacific Voice Conference and was asked to write about one specific pair of terms for the Division 3 Newsletter: the terms vocal abuse and misuse. In brief, the terms present a series of problems ranging from conceptual to ethical. Based on the considerations discussed in this commentary, I will take the strong view and propose that we discard the terms altogether from clinical use.
The first and most obvious problem with vocal abuse and misuse is circularity. Neither term can be defined independently of the effect they are supposed to produce. Vocal fold tissue trauma supposedly is caused by some combination of vocal abuse, understood as an imprecise quantity (“too much,” “too loud” voice use), and vocal misuse, understood as an aberration of quality (“inefficient voice”). Yelling and screaming are supposedly examples of abuse;“in-appropriate pitch or loudness” are examples of misuse. However, on closer inspection, one finds that yelling and screaming are considered abusive only if they result in tissue changes; otherwise, they are notabusive. Similarly, various pitch and loudness conditions are considered misuse if they conspire with abuse to produce organic pathology, or otherwise produce clinical complaints; otherwise, not. Here we have a bona fide case of circularity on our hands: abuse and misuse lack independent definition. This is no small conceptual shortcoming. The causal logic is inherently flawed.
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