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Objectives: Functional dysphonias are disorders of the voice characterized by sound and efficiency disturbances of the voice without any organic changes of structures being detectable. At present, functional dysphonias are generally subclassified into hyper- and hypofunctional dysphonias in clinical practice. Study Design: The study was designed for a critical evaluation of the relevance of stroboscopy to the diagnostics and classification of functional dysphonias. Methods: 45 patients were examined (27 hyperfunctional, 15 hypofunctional and 3 mixed type) using videostroboscopy. Several stroboscopic parameters were taken into consideration. Three geometrical and three time-dependent parameters were first analyzed in a uni- and multidimensional way, then cluster analyses were performed. Results: We could not confirm the clinical subdivision into hyper- and hypofunctional dysphonias as based on anamnestic data, perceptual evaluation of voice sound, voice profile measurements and videostroboscopy. Quantitative measurements of selected parameters did not correlate with qualitative subjective stroboscopic assessment. In addition to this, it was not possible to identify separate clusters of stroboscopic findings. Conclusions: The results do not deny the clinical relevance of stroboscopy to the diagnostics of functional dysphonias as a very useful tool to exclude organic lesions. However, a reliable subclassification into different types of functional dysphonias was not possible.

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In my report I made two recommendations: that we call the vertical axis either vocal fold contact area or we call it conductance or something of that ilk. I agree with Dr. Titze that it is not possible to scale that vertical axis. There is unlikely to be a linear transform of the vocal fold contact area. I tend to support his recommendation that we not call it vocal fold contact area per se, although that term has appeared in the literature in the last several years. I do not know of a good alternative term. Conductance comes to mind for purely electronic reasons. If we call it impedance then we have to graph it upside down. Another important point is that we cannot discern a true zero line on the electroglottogram (EGG). We can make assumptions about the beginning of contact but the so-called open phase should be flat, in theory. In theory, therefore, we should be able to say that the lowest part of the curve represents zero vocal fold contact. The fact is that we are never absolutely sure of that. The flat portion is rarely actually flat. There may be some minor vocal fold contact, perhaps at the anterior commissure, that is influencing the curve. There is also the influence, which is small but real, of other events distant from the glottis. These are periglottal events that we really cannot account for. The thing that worries me Address correspondence and reprint requests to Diane M.

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Starting out with an attempt to define an 'ideal voice', the discussion moved on to the hazards of pop singing, followed by the topics of harsh voices (from the desired effects in modern singing expression to devastating clinical cases), phoniatric targets (aesthetics and fitness), and, finally, the phoniatricians' attitudes comprising acceptance, neglect, and rejection. Therapy should aim at a resilient and effective voice regardless of the mere sound, unless the perfection of the vocal sound is the ultimate goal. In addition, the panellists agreed that voice specialists and all friends of healthy and efficient voices are obliged permanently to engage in voice care.