Voice Diagnostics: Current US American, European and German voice assessment guidelines - a comparison of recommended methods

Meike Brockmann-Bauser; Annerose Keilmann; Antonia Schuster; Ulla Beushausen

doi:10.2478/ijvs-2025-0004

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Voice Diagnostics: Current US American, European and German voice assessment guidelines - a comparison of recommended methods

IJVS International Journal of Voice Sciences

Volume 1 (2026): Issue 1 (July 2026)

By: Meike Brockmann-Bauser, Annerose Keilmann, Antonia Schuster and Ulla Beushausen

Open Access

|Jul 2026

Abstract

International recommendations on clinical voice assessment call for multidimensional, evidence-based protocols, yet national guidelines differ in scope and standardisation. This narrative review compares open-access standards of the American Speech-Language-Hearing Association (ASHA), the European Laryngological Society with the Union of European Phoniatricians (ELS–UEP) and the German Society of Phoniatrics and Pediatric Audiology (DGPP).

Across guidelines, there is general consensus that a voice assessment should include a detailed case history, visual laryngeal examination, patient-reported outcome measures (PROMs), auditory-perceptual evaluation, and acoustic and aerodynamic measurements. Differences arise in the weighting of domains, the definition of basic versus extended standards, and the specification of technical requirements and reporting formats. While ASHA offers the most detailed technical recommendations for visual, acoustic and aerodynamic techniques including reporting, the European guideline emphasises a short protocol for visual, perceptual acoustic and aerodynamic parameters. The German guideline provides the most comprehensive description of case history aspects and the measurement of different voice range profile types, and discusses a basic and extended standard including all assessment domains. In all guidelines, adapted protocols are recognised for professional voice users and children, but only partly specified. Underlying reasons for differing recommendations across guidelines include the literature search and consensus finding strategy, availability of validated questionnaires in specific languages and considerations regarding the respective healthcare services. This comparison highlights the need for international harmonisation of current feasible standards and strategies to integrate future technologies including AI driven assessment approaches, transparent reporting of results and shared normative datasets.

References

Al-Hussain, G., Shuweihdi, F., Alali, H., Househ, M., & Abd-Alrazaq, A. (2022). The Effectiveness of Supervised Machine Learning in Screening and Diagnosing Voice Disorders: Systematic Review and Meta-analysis. Journal of Medical Internet Research, 24(10), e38472. https://doi.org/10.2196/38472
Search in Google Scholar Back to article
AWMF. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. (2025 a). Die AWMF – Die starke Stimme der wissenschaftlichen Medizin. https://www.awmf.org/die-awmf
Search in Google Scholar Back to article
AWMF. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. (2025 b). Stufenklassifikationen. AWMF-Regelwerk Leitlinien. https://www.awmf.org/regelwerk/stufenklassifikationen
Search in Google Scholar Back to article
Baker, C. P., Sundberg, J., Purdy, S. C., Rakena, T. J, & Leão, S. H. de S. (2024). CPPS and Voice-Source Parameters: Objective Analysis of the Singing Voice. Journal of Voice: Official Journal of the Voice Foundation, 38(3), 549–560. https://doi.org/10.1016/j.jvoice.2021.12.010
Search in Google Scholar Back to article
Bensoussan, Y., Elemento, O., & Rameau, A. (2024). Voice as an AI Biomarker of Health-Introducing Audiomics. JAMA Otolaryngology Head & Neck Surgery, 150(4), 283–284. https://doi.org/10.1001/jamaoto.2023.4807
Search in Google Scholar Back to article
Berger, T., Peschel, T., Vogel, M., Pietzner, D., Poulain, T., Jurkutat, A., Meuret, S., Engel, C., Kiess, W., & Fuchs, M. (2019). Speaking Voice in Children and Adolescents: Normative Data and Associations with BMI, Tanner Stage, and Singing Activity. Journal of Voice: Official Journal of the Voice Foundation, 33(4), 580.e21-580.e30. https://doi.org/10.1016/j.jvoice.2018.01.006
Search in Google Scholar Back to article
Beushausen, U., Bohlender, J., Brockmann-Bauser, M., Caffier, P., Dicks, P., Deuster, D., Echternach, M., Fuchs, M., Hülse, R., Jungheim, M., Keilmann, A., Lehnert, B., Mürbe, D., Nawka, T., Richter, B., Schönweiler, R., Schützenberger, A., Traser, L., & Voigt-Zimmermann, S. (2023). S2k.Leitlinie. Diagnostik und Therapie von Störungen der Stimmfunktion (Dysphonien), (AWMF-Registernummer 049 – 008; Version 4.0). AWMF-Institut für Medizinisches Wissensmanagement. https://www.awmf.org/service/awmf-aktuell/diagnostik-und-therapie-von-stoerungender-stimmfunktion-dysphonien
Search in Google Scholar Back to article
Boominathan, P., Samuel, J., Arunachalam, R., Nagarajan, R., & Mahalingam, S. (2014). Multi parametric voice assessment: Sri ramachandra university protocol. Indian Journal of Otolaryngology and Head and Neck Surgery: Official Publication of the Association of Otolaryngologists of India, 66(Suppl 1), 246–251. https://doi.org/10.1007/s12070-011-0460-y
Search in Google Scholar Back to article
Brockmann-Bauser, M. (2025). How Well Will AI Help Recognize Voice Disorders? A State-of-the-art Review of Current Acoustic Assessment Strategies and Future Applications. World Journal of Otorhinolaryngology - Head and Neck Surgery, n/a(n/a). https://doi.org/10.1002/wjo2.70015
Search in Google Scholar Back to article
Brockmann-Bauser, M., de Paula Soares, M. F. (2023). Do We Get What We Need from Clinical Acoustic Voice Measurements? Applied Sciences, 13(2), 941.
Search in Google Scholar Back to article
Carding, P. N., Wilson, J. A., Mackenzie, K., & Deary, I. J. (2009). Measuring voice outcomes: State of the science review. The Journal of Laryngology & Otology, 123(8), 823–829. DOI: 10.1017/S0022215109005398
Search in Google Scholar Back to article
Cohen, SM., Jacobson, BH., Garrett, CG., Noordzij, JP., Stewart, MG., Attia, A. u. a. Creation and validation of the Singing Voice Handicap Index. Ann Otol Rhinol Laryngol. Juni 2007;116(6):402–6.
Search in Google Scholar Back to article
Dejonckere, P. H., Bradley, P., Clemente, P., Cornut, G., Crevier-Buchmann, L., Friedrich, G., Van de Heryning, P., Remacle, M., & Woisard, V. (2001). A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee on Phoniatrics of the European Laryngological Society (ELS). European Archives of Otorhinolarygology, 258, 77–82. https://doi.org/10.1007/s004050000299
Search in Google Scholar Back to article
DGPP. Deutsche Gesellschaft für Phoniatrie und Pädaudiologie e. V. (2022). Leitlinienreport zur S2k-Leitlinie Diagnostik und Therapie von Störungen der Stimmfunktion (Dysphonien) (AWMF-Registernummer 049-008). AWMF-Institut für Medizinisches Wissensmanagement. https://register.awmf.org/de/leitlinien/detail/049-008
Search in Google Scholar Back to article
Dienerowitz, T., Peschel, T., Vogel, M., Poulain, T., Engel, C., Kiess, W., Fuchs, M., & Berger, T. (2021). Establishing normative data on singing voice parameters of children and adolescents with average singing activity using the voice range profile. Folia Phoniatrica et Logopaedica, 73(6), 565–576. https://doi.org/10.1159/000517774
Search in Google Scholar Back to article
Friedrich, G.& Dejonckere, P. H. (2005). Das Stimmdiagnostik-Protokoll der European Laryngological Society (ELS)—Erste Erfahrungen im Rahmen einer Multizenterstudie. Laryngo-Rhino-Otologie, 84(10), 744–752. https://doi.org/10.1055/s-2005-861450
Search in Google Scholar Back to article
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical Research Ed.), 336(7650), 924–926. https://doi.org/10.1136/bmj.39489.470347.AD
Search in Google Scholar Back to article
Grässel, E., Hoppe, U., Rosanowski, F. (2008). Graduierung des Voice-Handicap-Index. HNO. 56(12).
Search in Google Scholar Back to article
Hogikyan, ND., Sethuraman, G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice Dezember 1999;13(4):557–69.
Search in Google Scholar Back to article
Lechien, J. R., Geneid, A., Bohlender, J. E., Cantarella, G., Avellaneda, J. C., Desuter, G., Sjogren, E. V., Finck, C., Hans, S., Hess, M., Oguz, H., Remacle, M. J., Schneider-Stickler, B., Tedla, M., Schindler, A., Vilaseca, I., Zabrodsky, M., Dikkers, F. G., & Crevier-Buchman, L. (2023). Consensus for voice quality assessment in clinical practice: Guidelines of the European Laryngological Society and Union of the European Phoniatricians. European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 280(12), 5459–5473. https://doi.org/10.1007/s00405-023-08211-6
Search in Google Scholar Back to article
Lorenz, A., Kleber, B., Büttner, M., Fuchs, M., Mürbe, D., Richter, B., u. a. Validierung des Singing Voice Handicap Index in der deutschen Fassung. HNO. August 2013;61(8):699–706.
Search in Google Scholar Back to article
Lukaschyk, J., Abel, J., Brockmann-Bauser, M., Keilmann, A., Braun, A., Rohlfs, AK. Cross-Validation and Normative Values for the German Vocal Tract Discomfort Scale. J Speech Lang Hear Res. 2021 Jun 4;64(6):1855-1868.
Search in Google Scholar Back to article
Lukaschyk, J., Brockmann-Bauser, M., Beushausen, U. Transcultural Adaptation and Validation of the German Version of the Vocal Tract Discomfort Scale. J Voice. März 2017;31(2):261.e1-261.e8.
Search in Google Scholar Back to article
Mathieson, L., Hirani, SP., Epstein, R., Baken, RJ., Wood, G., Rubin, JS., Laryngeal manual therapy: a preliminary study to examine its treatment effects in the management of muscle tension dysphonia. J Voice. 2009 May;23(3):353-66.
Search in Google Scholar Back to article
Nawka, T1., Wiesmann, U., Gonnermann, U., Validierung des Voice Handicap Index (VHI) in der deutschen Fassung. HNO. November 2003;51(11):921–30.
Search in Google Scholar Back to article
Nusseck, M., Richter, B., Echternach, M., Spahn, C. Entwicklung eines Fragebogens zur Erfassung des stimmlichen Selbstkonzepts. HNO 2015;63(2):125–31.
Search in Google Scholar Back to article
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoff-mann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Search in Google Scholar Back to article
Patel, R. R., Awan, S. N., Barkmeier-Kraemer, J., Courey, M., Deliyski, D., Eadie, T., Paul, D., Svec, J. G., & Hillman, R. (2018). Recommended Protocols for Instrumental Assessment of Voice: American Speech-Language-Hearing Association Expert Panel to Develop a Protocol for Instrumental Assessment of Vocal Function. Am J Speech Lang Pathol, 27(3), 887–905. https://doi.org/10.1044/2018_ajslp-17-0009
Search in Google Scholar Back to article
Payten, C. L., Weir, K. A., & Madill, C. J. (2024). Investigating current clinical practice in assessment and diagnosis of voice disorders: A cross-sectional multidisciplinary global web survey. International Journal of Language & Communication Disorders, 59(6), 2786–2805. https://doi.org/10.1111/1460-6984.13116
Search in Google Scholar Back to article
Reetz, S., Bohlender, J. E., & Brockmann-Bauser, M. (2019). Do Standard Instrumental Acoustic, Perceptual, and Subjective Voice Outcomes Indicate Therapy Success in Patients With Functional Dysphonia? J Voice, 33(3), 317–324. https://doi.org/10.1016/j.jvoice.2017.11.014
Search in Google Scholar Back to article
Roy, N., Barkmeier-Kraemer, J., Eadie, T., Sivasankar, M. P., Mehta, D., Paul, D., & Hillman, R. (2013). Evidence-based clinical voice assessment: A systematic review. Am J Speech Lang Pathol, 22(2), 212–226. https://doi.org/10.1044/1058-0360(2012/12-0014)
Search in Google Scholar Back to article
Rusz, J., Tykalova, T., Ramig, L. O., & Tripoliti, E. (2021). Guidelines for Speech Recording and Acoustic Analyses in Dysarthrias of Movement Disorders. Movement Disorders: Official Journal of the Movement Disorder Society, 36(4), 803–814. https://doi.org/10.1002/mds.28465
Search in Google Scholar Back to article
Schwartz, S., Cohen, S., Dailey, S., Rosenfeld, R., Deutsch, E., Gillespie, M., Granieri, E., Hapner, E., Kimball, C., Krouse, H., McMurray, J., Medina, S., O’Brien, K., Ouellette, D., Messinger-Rapport, B., Stachler, R., Strode, S., Thompson, D., Stemple, J., … Patel, M. (2009). Clinical practice guideline: Hoarseness (dysphonia). Otolaryngology–Head and Neck Surgery, 141(3 Suppl. 2), S1–S31. https://doi.org/10.1016/j.otohns.2009.06.744
Search in Google Scholar Back to article
Sood, S., Street, I., & Donne, A. (2017). Hoarseness in children. British Journal of Hospital Medicine, 78(12), 678–683. https://doi.org/10.12968/hmed.2017.78.12.678
Search in Google Scholar Back to article
Stachler, R. J., Francis, D. O., Schwartz, S. R., Damask, C. C., Digoy, G. P., Krouse, H. J., McCoy, S. J., Ouellette, D. R., Patel, R. R., Reavis, C. C. W., Smith, L. J., Smith, M., Strode, S. W., Woo, P., & Nnacheta, L. C. (2018). Clinical Practice Guideline: Hoarseness (dysphonia) (Update) – Executive Summary. Otolaryngology–Head and Neck Surgery, 158(3), 409–426. https://doi.org/10.1177/0194599817751031
Search in Google Scholar Back to article
Umeno, H., Hyodo, M., Haji, T., Hara, H., Imaizumi, M., Ishige, M., Kumada, M., Makiyama, K., Nishizawa, N., Saito, K., Shiromoto, O., Suehiro, A., Takahashi, G., Tateya, I., Tsunoda, K., Shiotani, A., & Omori, K. (2020). A Summary of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018 in Japan. Auris, Nasus, Larynx, 47(1), 7–17. https://doi.org/10.1016/j.anl.2019.09.004
Search in Google Scholar Back to article
Van Houtte, E., Van Lierde, K., D‘Haeseleer, E., & Claeys, S. (2010). The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia. Laryngoscope, 120(2), 306–312. https://doi.org/10.1002/lary.20696
Search in Google Scholar Back to article
Voigt-Zimmermann, S., Schönweiler, R., Fuchs, M., Beushausen, U., Kollbrunner, J., Ribeiro von Wersch, A. & Keilmann, A. (2015). Dysphonien bei Kindern – Teil 2: Interdisziplinärer Konsens zu Diagnostik und Therapie. Sprache – Stimme – Gehör, 39(1), 44 – 51. https://doi.org/10.1055/s-0035-1545295
Search in Google Scholar Back to article
Yao, D., Koivu, A., & Simonyan, K. (2025). Applications of Artificial Intelligence in Neurological Voice Disorders. World Journal of Otorhinolaryngology - Head and Neck Surgery, n/a(n/a). https://doi.org/10.1002/wjo2.70017
Search in Google Scholar Back to article
Zur, K. B., Cotton, S., Kelchner, L., Baker, S., Weinrich, B., & Lee, L. (2007). Pediatric Voice Handicap Index (pVHI): A new tool for evaluating pediatric dysphonia. International Journal of Pediatric Otorhinolaryngology, 71(1), 77–82. https://doi.org/10.1016/j.ijporl.2006.09.004
Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.2478/ijvs-2025-0004 | Journal eISSN: 3054-4343

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Language: English

Page range: 52 - 66

Submitted on: Nov 30, 2025

Accepted on: Dec 25, 2025

Published on: Jul 23, 2026

Published by: Hochschule für angewandte Wissenschaft und Kunst, Hildesheim/Holzminden/Göttingen

In partnership with: Paradigm Publishing Services

Publication frequency: 2 issues per year

Keywords:

voice assessment,

dysphonia,

international guidelines,

evidence-based practice

Related subjects:

Medicine,

Clinical medicine,

Clinical medicine, other,

Otorhinolaryngology,

Speech, voice and paediatric hearing disorders,

Social sciences,

Communication science,

Health communication

© 2026 Meike Brockmann-Bauser, Annerose Keilmann, Antonia Schuster, Ulla Beushausen, published by Hochschule für angewandte Wissenschaft und Kunst, Hildesheim/Holzminden/Göttingen
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 1 (2026): Issue 1 (July 2026)