Plural Publishing produces leading academic, scientific and clinical publications in the fields of speech-language pathology, audiology, and otolaryngology.


Clinical Voice Pathology
Theory and Management

Fifth Edition
Joseph C. Stemple, Nelson Roy, Bernice K. Klaben
468 pages, B/W With Color Insert, Softcover, 7 x 10"
Release Date:



Clinical Voice Pathology: Theory and Management, Fifth Edition, is a compilation of the authors' many years of experience in a multitude of settings and addresses a considerable range of voice disorders in various populations and from various etiologies including medical, environmental, social, psychological, occupational, and even idiopathic threats to vocal health. The addition of world-renowned coauthor, Nelson Roy, brings this fifth edition even more valuable experience in clinical voice disorders research.

Whether a typical voice user, occupational voice user, elite vocal performer, head and neck cancer client, or an individual who has lost the ability to communicate competently and confidently due to a detrimental voice change, each patient presents a unique diagnostic dilemma: how best to return the voice to its optimal condition? This text thoroughly answers this question through explaining and illustrating the knowledge necessary to treat and manage voice disorders.

Key features to the fifth edition:

  • Provides the history and common causes of voice disorders, introducing the interdisciplinary background essential to successful voice therapy and treatment planning
  • Details the anatomy and physiology of voice production to aid in identification and evaluation measures
  • Reviews criteria for a comprehensive voice assessment, such as high speed digital imaging and videokymography tools, as well as several voice therapy approaches, including hygienic, symptomatic, psychogenic, physiologic, and eclectic treatments
  • Highlights current clinical evidence that either supports or refutes popular voice therapy treatments for conditions such as papilloma, mutational falsetto, and transgendered voice
  • Presents the pathologies of the laryngeal mechanism, organized according to ASHA’s Classification Manual for Voice Disorders
  • Provides guidance for management and rehabilitation of the laryngectomized patient, outlining the complementary roles of the interdisciplinary treatment team to manage multiple treatment goals

With numerous pieces of artwork, full color inserts, and case examples, Clinical Voice Pathology, Fifth Edition, not only maintains but also significantly improves on the standards set by its previous editions.


  • Janet Baker L.A.C.S.T. MSc PhD, Speech Pathologist and Family Therapist Clinical Consultant in Voice and Counselling Supervision of Professional Practice, Adjunct Associate Professor, Speech Pathology, Flinders University, Speech Language and Hearing (September 2014):
    "Clinical Voice Pathology: Theory and Management, is the 5th edition of this well-known textbook, with new input from co-author, Nelson Roy. It is intended pri-marily for speech-language pathologists, and it is written in a way that makes it readily accessible to students and academics in undergraduate and postgraduate speech pathology programs, and to practitioners in the field. ...

In addition to the subjective and instrumental approaches involved in the comprehensive assessment procedures and differential diagnosis, there are helpful examples of the kinds of questions that a clinician may ask, and ways in which practitioners may explain their rationale for probing further. Case examples are included to illustrate how management might proceed following different diagnoses, and it is excellent to see chapters devoted to the professional voice and laryngectomy. ...

The strength of this new edition is that it provides a sound overview of foundation knowledge and practices involved in the specialty of voice pathology, and a strong focus on the crucial contribution of the speech-language pathologist. It is written in a style that is consistent throughout, easy to understand, and engaging in its emphasis on empirical evidence and clinical practice. The authors refer to the importance of the clinician-scientist, and the book reflects the work of three master clinicians who have generously shared their integrated knowledge from their extensive experience in teaching, research, and clinical practice.

  • Doody's (May 2018):
    "Named to Doody's Core Titles in the Health Sciences - Speech, Language & Hearing 2018 list."

  • Dawn Sadoway, St. Thomas University, New Brunswick, Canada, Voice and Speech Review (October 30, 2014):
    "This text is successful in giving a broad overview of the world of clinical voice pathology with clear descriptions of some of the most common voice disorders and why they may exist. . . . Already established as a text for clinical practice, this new edition continues to serve this population well. However, because the writing is so clear and accessible, Clinical Voice Pathology is a text that belongs on any voice practitioner or pedagogue’s shelf. My own copy is already well thumbed and I have been drawn to it for concise scientific descriptors of anatomy, physiology and voice pathologies. The artwork in this edition is entirely new and there are also full color inserts, charts and case samples. All of these supporting visual materials and case studies are accessible and relevant to both the scientist and the artist making it an excellent reference for all voice practitioners, pedagogues and clinicians."


  • 1. Voice: A Historical Perspective
    • Ancient History
    • The Renaissance
    • The 17th to 19th Centuries
    • The Laryngeal Mirror
    • Further Advancements
    • Voice Therapy
    • Clinical Voice Pathology
    • References

  • 2. Anatomy and Physiology
    • Anatomy
      • The Laryngeal Valve
      • Respiration for Phonation
    • Vocal Tract Resonance
    • Structural Support for the Larynx
      • Hyoid Bone
      • Laryngeal Cartilages
    • Muscles
      • Muscles for Respiration: Inspiration and Exhalation
      • Laryngeal Muscles
    • True Folds, Ventricular (False) Folds, and Ventricle
    • Vocal Fold Microstructure
      • Epithelium
      • Basement Membrane Zone
      • Lamina Propria
      • Vocal Muscle
    • Blood Supply and Secretions
    • Neurologicl Supply
      • Central Nervous System Control
      • Peripheral Innervation
    • Laryngeal Reflexes
    • Developmental Changes
    • Geriatric Vocal Folds
    • DNA Mircoarray Gene Expression Analysis
    • Physiology of Phonation
      • Theories of Vibration
      • Fundamental Frequency Control
      • Intensity Control
      • Phonation Modes and Voice Quality Control
    • Summary
    • References

  • 3. Some Etiologic Correlates
    • Etiologies of Vocal Misuse
      • Phonotrauma
      • Inappropriate Vocal Components
    • Medically Related Etiologies
      • Direct Surgery
      • Indirect Surgery
      • Chronic Illnesses and Disorders
    • Primary Disorder Etiologies
    • Personality-Related Etiologies
      • Environmental Stress
      • Identify Conflict
    • Summary
    • References

  • 4. Pathologies of the Laryngeal Mechanism
    • Prevalence of Voice Disorders
    • Pathology Classifications
      • Structural Pathologies of the Vocal Fold
      • Congenital and Maturational Changes Affecting Voice
      • Inflammatory Conditions of the Larynx
      • Trauma or Injury of the Larynx
      • Systematic Condition Affecting Voice
      • Allergies
      • Nonlaryngeal Aerodigestive Disorders Affecting Voice
      • Psychiatric and Psychological Disorders Affecting Voice
      • Neurological Disorders Affecting Voice
      • Movement Disorders Affecting the Larynx
      • Central Neurological Disorders Affecting the Voice
      • Other Disorders of Voice Use
    • Summary
    • References

  • 5. The Diagnostic Voice Evaluation
    • The Management Team
    • Patient Profile
    • Referral Sources
    • Medical Evaluation
    • Voice Pathology Evaluation
    • Diagnostic Voice Evaluation
      • Referral
      • Reason for the Referral
      • History of the Problem
      • Oral-Peripheral Examination
      • Auditory-Perceptual Voice Assessment
      • Patient Self-Analysis of the Voice Disorder
      • Impressions
      • Prognosis
      • Recommendations
      • Additional Considerations
    • Summary
    • References
    • Appendix 5-A. Sample Report
    • Appendix 5-B. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)
    • Appendix 5-C. The Rainbow Passage
    • Appendix 5-D. Vocal Component Checklist
    • Appendix 5-E. Voice Handicap Index (VHI)

  • 6. Instrumental Measurement of Voice
    • Introduction to Instrumentation in Voice Assessment
    • Clinical Utility
    • Basics of Technical Instruments
    • Microphones and Recording Environment
    • Digital Signal Processing
    • Acoustic Measurements
      • Pitch Detection Algorithm
      • Fundamental Frequency
      • Intensity
      • Voice Range Profile, Phonetogram, and Physiologic Frequency Range of Phonation
      • Perturbation Measures
      • Signal (or Harmonic)-to-Noise Ratios
      • Spectral Analysis
      • Cepstral Spectral Index of Dysphonia (CSID)
    • Aerodynamic Measures
      • Calibration
      • Pressure, Flow, Resistance, and Ohm's Law
      • Airflow Equipment
      • Flow Measurement
      • Subglottal Air Pressure Measurement
      • Phonation Threshold Pressure
      • Laryngeal Resistance
      • Inverse Filter
    • Laryngeal Imaging
      • Endoscopy
      • Stroboscopy
      • High-Speed Digital Imaging
      • Kymography
      • Criteria for Laryngeal Imaging
      • Recording Protocol
      • Visual Perceptual Judgements
    • Electroglottography (EGG)
    • Laryngeal Electromyography (LEMG)
    • Normative Information
    • Electrical Safety
    • Hygienic Safety
    • The Clinical Voice Laboratory
    • Glossary
      • Acoustics
      • Aerodynamics
    • References
    • Appendix 6-A. Joint Statement: ASHA and AAO-HNS
    • Appendix 6-B. Vocal Tract Visualization and Imaging: Position Statement

  • 7. Survey of Voice Management
    • Voice Therapy Orientations
      • Hygienic Voice Therapy
      • Symptomatic Voice Therapy
      • Psychogenic Voice Therapy
      • Physiologic Voice Therapy
      • Eclectic Voice Therapy
      • Case Study 1
    • Hygienic Voice Therapy
      • Treatment Strategies for Vocally Traumatic Behavior
      • Vocal Hygiene Therapy Approaches
      • Case Study 2: The Homemaker
      • Case Study 3: The Noisy Job Environment
      • Case Study 4: The Public Speaker
      • Case Study 5: Phonotrauma in Children
      • Case Study 6: Can We Always Expect Success?
      • Hydration
      • Confidential Voice
    • Symptomatic Voice Therapy
      • Therapy Approaches for Respiration
      • Therapy Approaches for Phonation
      • Therapy Approaches for Resonance
      • Therapy Approaches for Pitch
      • Therapy Approaches for Gender Reassignment Voice Change
      • Therapy Approaches for Loudness Modification
      • Therapy Approaches for Rate Modification
      • Therapy Approaches for Laryngeal Area Muscle Tension
    • Psychogenic Voice Therapy
      • Functional Aphonia/Dysphonia
      • Functional Falsetto
      • Vocal Chord Dysfunction (VCD)
    • Physiologic Voice Therapy
      • Case Study 11: Laryngeal Muscle Imbalance
      • Case Study 12: The Postsurgical Patient
      • Case Study 13: Presbyphonia
      • Vocal Function Exercises
      • Resonant Voice Therapy
      • Accent Method of Voice Therapy
      • Lee Silverman Voice Treatment
    • Team Management of Specific Laryngeal Pathologies
      • Vocal Fold Cover Lesions
      • Laryngopharyngeal Reflux and Gastroesophageal Reflux Disease
      • Unilateral Vocal Fold Paralysis
      • Case Study 14: Unilateral Vocal Fold Paralysis
      • Spasmodic Dysphonia
    • Successful Voice Therapy
    • Refernces
    • Appendix 7-A. Phrases and Sentences Graduated in Length
      • Paragraph Readings
      • Poetry Readings

  • 8. The Professional Voice
    • Overview
    • The Professional Voice User
    • History
    • The "At-Risk" Status
    • Professional Roles
      • The Otolaryngoloist
      • The Voice Pathologist
      • The Produces
      • The Agent or Manager
    • Clinical Pathways
      • Otolaryngology-Voice Pathology-Voice Pedagogy
      • Voice Pedagogy-Otolaryngoloist-Voice Pathology
      • Voice Pedagogy-Voice Pathology-Otolaryngology
      • Otolaryngology-Voice Pedagogy
      • Voice Pathologist-Voice Pedagogy
      • Vocal Types and Vocal Range
    • Categories of Singers
    • Vocal Registers
    • Common Etiologic Factors
      • Personality Factors
      • Phonotrauma
      • Drugs
      • Hydration
    • Common Pathologies
      • Acute and Chronic Noninfectious Laryngitis
      • Vocal Nodules
      • Contact Ulcers and Granulomas
      • Gastroesophageal Reflux Disease/Laryngopharyngeal Reflux
      • Voice Fatigue
      • Vocal Fold Hemorrhage and Vascular Pathologies
    • Clinical Assessment of the Vocal Performer
    • Supportive Training and Techniques
      • Alexander Technique
      • The Linklater Method
      • The Feldenkrais Method
      • The Lessac System
      • Estill Voice Training
    • Summary
    • Glossary of Terms Used in Singing
    • References

  • 9. Rehabilitation of the Laryngectomized Patient
    • Overview
    • Incidence of Laryngeal Cancer
    • Etiology
    • Symptoms of Laryngeal Cancer
    • Medical Evaluation
    • Staging and Tumor-Node-Metastasis Classification
    • Lymph Node Distribution
    • Treatment Options
      • Conservation
      • Combined Treatments
      • Radiation Therapy
      • Surgery
      • Concurrent Chemoradiotherapy
    • Methods of Reconstruction
    • Needs for Follow-Up Treatment
      • Multidisciplinary Rehabilitation Team
    • Special Concerns of the Laryngectomized Patient
      • Communication
      • Physical Concerns
      • Psychosocial Concerns
    • Speech Rehabilitation
      • Artificial Larynges
      • Esophageal Speech
      • Surgical Prothetics
    • Role of the Speech-Language Pathologist and Surgical Prothetics
      • Patient Evaluation
      • Patient Fitting
      • Independent Care
      • Maximizing Communication
      • Hands-Free Speaking Valve
    • Summary
    • Helpful Websites on Head and Neck Cancers
    • Refernces


About The Authors

Joseph C. Stemple

Joseph C. Stemple, PhD, CCC-SLP, ASHAF, is professor of Communication Sciences and Disorders, College of Health Sciences, University of Kentucky where he specializes in the study of voice production and disorders. Current research interests include the biology of laryngeal muscles during exercise; the aging voice; and identifying the active ingredients of evidence-based voice therapy programs. Dr. Stemple is an active national and international speaker and lecturer. He is a Fellow and Honors recipient of the American Speech-Language-Hearing Association.

Nelson Roy

Nelson Roy, PhD, CCC-SLP, ASHAF, is a professor of speech-language pathology in the Department of Communication Sciences and Disorders at The University of Utah, where he specializes in the study of the voice and its disorders. Dr. Roy has published extensively on the topic of voice disorders including epidemiology, psychological/personality factors, treatment outcomes, differential diagnosis, acoustics, and the direct and indirect economic costs of disordered voice. Dr. Roy is a Fellow of the American Speech-Language-Hearing Association.

Bernice K. Klaben

Bernice K. Klaben, PhD, CCC-SLP, BCS-S, is an associate professor in the Department of Otolaryngology-Head and Neck Surgery at the University of Cincinnati Medical Center (UCMC) / UC Voice and Swallowing Center. She is an Adjunct Instructor in the College of Allied Health Sciences in the Communication Science Department at the University of Cincinnati. Her specialty is in the areas of voice, dysphagia, and head and neck cancer at the University of Cincinnati Voice and Swallowing Center providing full assessments and rehabilitation. Dr. Klaben is board certified in swallowing and swallowing disorders. She was awarded a Senior Representative Fulbright Scholarship to Bulgari and has given numerous presentations and seminars in the areas of voice and swallowing and served as mentor to many students in the field of medical speech pathology.

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