Vocal quality	Suggested diagnoses
Breathy	Inflammatory arthritis, spasmodic or functional dysphonia, vocal cord mass, vocal cord paralysis
Halting, strangled	Spasmodic dysphonia
Hoarse, husky, muffled, or nasal-sounding	Parkinson disease
Hoarseness worse early in the day	Laryngopharyngeal reflux
Hoarseness worse later in the day	Myasthenia gravis, vocal abuse
Honking	Sarcoidosis
Low pitched	Hypothyroidism, laryngopharyngeal reflux, leukoplakia, muscle tension dysphonia, Reinke edema, vocal cord edema, vocal cord paralysis
Raspy or harsh	Laryngopharyngeal reflux, muscle tension dysphonia, vocal cord lesion
Scanning speech and dysarthria	Multiple sclerosis
Soft (loss of volume)	Vocal cord paralysis, Parkinson disease
Spoken voice lost, but whispered voice maintained	Conversion aphonia
Strained, effortful phonation	Muscle tension dysphonia
Strained	Laryngopharyngeal reflux, muscle tension dysphonia, spasmodic dysphonia
Thick, deep voice and slowed speech	Acromegaly
Vocal fatigue	Muscle tension dysphonia, myasthenia gravis, Parkinson disease, vocal abuse