Dr. Dhanshree R Gunjawate

Assistant Professor

Department of Audiology & Speech Language Pathology (at Mangalore)


    • Teaching: Undergraduate and Post graduate students
    • Clinical supervision and patient care
    • Internship coordinator
    • Incharge of voice lab
    • Guide: Conference presentations/Clinical & Journal clubs 


Subject Subject code Semester
Voice and its disorders B 3.1 Third Semester BASLP
Speech Science and Production SH 102 First semester - M.Sc Speech Language Pathology)
Anatomy and physiology of Speech and Hearing B 1.2 First semester BASLP
Voice: Science and Disorders SLP 202 Second semester - M.Sc (Speech Language Pathology)
Practical in Speech Language Pathology SLP 401 Fourth semester - M.Sc (Speech Language Pathology)


Degree Specialisation Institute Year of passing
Doctorate in Philosophy in Speech and Hearing Speech Language Pathology School of Allied Health Sciences, Manipal University 2017
MASLP Speech & Hearing School of Allied Health Sciences, Manipal University 2013
BASLP Speech and Hearing Ali Yavar Jung National Institute of Speech and Hearing Disabilities 2011


Institution / Organisation Designation Role Tenure
Department of Audiology and Speech Language Pathology, KMC Mangalore Assistant Professor Teaching, Research, Clinical Management Oct 2017 - till date


Area of Interest

Voice, Speech disorders, Speech Science

Area of Expertise

Voice, Speech Science

Area of Research

Voice, Pediatric Audiology

Professional Affiliations & Contributions

  • Member of Rehabilitation Council of India (RCI), 2016
  • Member of Indian Speech and Hearing Association (ISHA), 2016.
  • Member of Dakshin Karnataka Indian Speech and Hearing Association (DKISHA), 2016.

Audiology Occupational Stress experienced by Audiologists practicing in India

2014-19-11 International Journal of Audiology, 2015, Vol 54(2), Pg 131-135 Ravi, R Gunjawate, D.R. Mohd. A.

Objective: The aim of the present study is to identify the levels of occupational stress across different types of setting, years of experience, and age. Design: A questionnaire-based observational research design using the audiology occupational stress questionnaire (AOSQ) was used. Study sample: The sample comprised of audiologists registered under the Indian Speech and Hearing Association. The questionnaire was sent via personal email to 400 audiologists, of which 100 responded. Results: Descriptive statistics and chi-square analysis were carried out. Participants in both the groups experienced stress to some extent, with more stress reported in private practitioners. Conclusion: This study helps to identify certain factors that contribute towards work-related stress. These in turn have an impact on the overall professional output of a professional.

Acoustic analysis of Madhya and Taar Saptak/Sthayi in Indian Classical singers

2015-19-05 Folia Phoniatrica et Logopedia, 2015, Vol 67(1), Pg 36-41 Gunjawate, D.R Aithal, U.V Guddattu, V. Rajashekhar, B

Objectives: We aimed to compare the acoustic parameters of voice between Madhya Saptak/Sthayi (MS) and Taar Saptak/Sthayi (TS) in trained Indian classical singers and between males and females. Participants and Method: Sixty-five adult trained Indian classical singers were instructed to produce MS and TS; the acoustic parameters were analyzed with the Multidimensional Voice Program. Descriptive statistics were used for analysis across tasks and gender. Two-way random-effects ANOVA was used to test the effect of gender and task. Results: Male participants had a restricted range of fundamental frequency (F0), especially at high pitches. The acoustic analysis showed a statistically significant difference for F0 measures, range of F0, jitter and pitch perturbation quotient between males and females during MS and TS. Conclusion: The use of TS, that is, high-pitch phonation, during the clinical evaluation of singers enables an understanding of their vocal behavior in the higher scales of singing.

Adaptation and validation of the Malayalam pediatric voice handicap index

2015-25-05 International Journal of Pediatric Otorhinolaryngology, 2015, Vol 79 (9), Pg 1425-1428 Devadas, D. Dhanya, M. Gunjawate, D.R.

OBJECTIVES: The aim of the present study was to adapt and validate the English version of pediatric voice handicap index (pVHI) into Malayalam language. METHODS: The English version of pediatric voice handicap index was translated into Malayalam language using parallel back translation. The translated version was content validated by three qualified speech language pathologists. The content familiarity was carried out by 10 parents of children with voice problems. This was distributed to 136 parents (57 parents of children with dysphonia, 79 parents of children with no voice problems). The internal consistency and test--retest reliability was determined using Cronbach's alpha and intraclass correlation coefficient. Independent sample t-test was used to assess the difference in means. Kappa coefficient was used to determine the correlation between overall severity of the problem and total pVHI. Discriminant analysis was used to identify thresholds for differentiating between normal and dysphonic participants. RESULTS: The results obtained revealed that the Malayalam version of pVHI has an excellent internal consistency; total (α=0.974), functional (α=0.922), physical (α=0.953), and emotional (α=0.923). There was an excellent test-retest reliability; total (r=0.937), functional (r=0.954), physical (r=0.95), and emotional (r=0.929). The prediction probability of the dysphonics is 98.2% using the discriminant score function. CONCLUSIONS: The translated and validated pVHI tool can be effectively used in the assessment of children with voice problems. It can provide a better insight into the parents' perception of their child's voice problems.

Exploring attitudes of Indian classical singers towards seeking vocal health care

2015-17-12 Journal of Voice, 2016, Vol 30(6), Pg 761 e23-761 e26 Gunjawate, D.R. Aithal, U.V. Guddattu, V. Kishore, A. Rajashekhar, B.

OBJECTIVE: The attitude of Indian classical singers toward seeking vocal health care is a dimension yet to be explored. The current study was aimed to determine the attitudes of these singers toward seeking vocal health care and further understand the influence of age and gender. STUDY DESIGN: Cross-sectional. METHOD: A 10-item self-report questionnaire adapted from a study on contemporary commercial music singers was used. An additional question was added to ask if the singer was aware about the profession and role of speech-language pathologists (SLPs). The questionnaire was administered on 55 randomly selected self-identified trained Indian classical singers who rated the items using a five-point Likert scale. Demographic variables were summarized using descriptive statistics and t test was used to compare the mean scores between genders and age groups. RESULTS: Of the singers, 78.2% were likely to see a doctor for heath-related problems, whereas 81.8% were unlikely to seek medical care for voice-related problems; the difference was statistically significant (P < 0.001). Responses for the questions assessing the attitudes toward findings from medical examination by a specialist revealed a statistically significant difference (P = 0.02) between the genders. Age did not have a significant influence on the responses. Only 23.6% of the respondents were aware about the profession and the role of SLPs. CONCLUSION: The findings are in tune with western literature reporting hesitation of singers toward seeking vocal health care and draws attention of SLPs to promote their role in vocal health awareness and management.

Prevalence and influencing risk factors of voice problems in priests in Kerala.

2015-22-12 Journal of Voice, 2016, Vol 30 (6), Pg 771 e27 – 771 e32. Devadas, U. Jose, N Gunjawate, D.R.

OBJECTIVE: Voice problems are commonly reported by professionals in occupations involving a large amount of voice loading. The aim of the present study was to investigate the prevalence of voice problems in Mar Thoma priests and identify possible risk factors responsible for voice problems. STUDY DESIGN: This is a cross-sectional study. METHOD: The study group consisted of 270 Mar Thoma priests with 1-35 years of professional experience. A self-reported questionnaire was used to collect the data. RESULTS: Mar Thoma priests were found to have higher career (47.8%) and year prevalence (25.2%) of voice problems with 17.8% of them reporting frequent voice problems during their career. Asthma, allergy and frequent throat clearing behavior were found to have significant association with priests reporting frequent voice problems. Significantly higher number of priests with frequent voice problems missed their work. CONCLUSION: The study results provide valuable preliminary information regarding the prevalence voice problems and associated risk factors in Mar Thoma priests. However, further investigations are required for in-depth understanding of the types of voice problems these priests experience and their impact on their quality of life.

Knowledge and attitude (KA) survey regarding infant hearing loss in Karnataka, India

2016-23-03 International Journal of Pediatric Otorhinolaryngology, 2016, Vol 85, Pg 1-4. Ravi, R Yerraguntla, K. Gunjawate, D.R. Rajashekhar, B. Lewis, L.E.

Introduction: The support provided and the decisions taken by mothers determine the success of Universal Newborn Hearing Screening (UNHS). Attempts at exploring the existing knowledge-attitude among mothers is crucial to create/modify the existing screening programs. The present study attempts to explore the knowledge and attitude toward infant hearing loss (HL) among mothers of newborns in the Indian state of Karnataka. Method: A cross-sectional survey was conducted among 219 mothers of newborns in Karnataka, India. The questionnaire was framed from existing literature and consisted of 19 questions assessing knowledge and attitude toward infant HL to be rated on a three-point scale (no, not sure, yes). Descriptive statistics and Cronbach's α were used to analyze the data. Results: Mothers exhibited good knowledge of risk factors; noise (70.3%) and ear discharge (54.3%). More than 75% agreed that treatment for HL is available and that these children can attend school. The questions of superstitions and cultural beliefs yielded mixed responses. A large number of mothers expressed desire to have their children tested at birth (84.9%) and were concerned about their children's hearing (87.7%). Yet only 54.3% stated that they would allow their children to wear hearing aids. Summary and conclusion: The present study is an attempt to understand the knowledge and attitude of mothers toward infant HL in Karnataka and facilitate identification of potential areas of less knowledge as a reference for endeavors of enhancement. It further highlights the need for implementing public awareness programs to improve knowledge and attitude of mothers toward infant HL for better implementation of UNHS.

The effect of menstrual cycle on singing voice: A systematic review

2016-24-05 Journal of Voice, 2017, Vol 31(2), Pg 188 – 194 Gunjawate, D.R. Aithal, U.V Ravi R Venkatesh, B.T.

OBJECTIVE: Research has reported the difference in a woman's voice across the different stages of the menstrual cycle. A review of the studies in singers on the influence of menstruation on the singing voice will enable a better understanding of these changes. METHODS/DESIGN: A systematic literature search was carried out on PubMed, CINAHL, Scopus, Cochrane, and regional electronic databases. The keywords "menstrual cycle," "voice change," and "singer" were used in different combinations. Only those articles that discussed the effect of menstrual cycle on the singing voice were included in the final review. RESULTS: Six studies in the English language were identified and included in the review. Hormonal variations occur to a great extent during menstrual cycle, and these variations can influence the voice of singers. A great variability was found in the included studies. There are limited studies that have been carried out exploring the relationship between menstrual cycle and the singing voice. CONCLUSION: Even though the studies included in the review point out toward the changes in the singing voice associated with menstrual cycle, there is a need for more studies to be carried out in diverse singing populations and in different outcome measures.

Professional quality of life in audiologists and speech language pathologists working in India

2016-07-06 Journal of Workplace Behavioural Health, 2016, Vol 31 (3), Pg 162- 172. Ravi, R Yerraguntla, K Gunjawate, D.R. Guddattu, V Rajashekhar, B.

The study aimed to investigate professional quality of life as reported by audiologists and speech language pathologists (SLPs) working in India. Questionnaire-based cross-sectional e-mail survey design using the Professional Quality of Life scale (ProQOL) was carried out. The sample consisted of professionals registered under the Indian Speech and Hearing Association. The questionnaire was sent through the personal registered e-mail-id to 500 professionals of which 155 complete responses were obtained. Descriptive statistics were used to summarize the demographic variables. Internal consistency was checked using Cronbach’s alpha. Independent sample t test was used to check the relation of occupation, gender and work setting with the ProQOL subscales. ANOVA and post hoc Tukey HSD was performed to determine the effect of years of experience. A statistically significant difference was found between occupation and secondary traumatic stress (STS) levels and years of work experience and burnout. Post hoc analysis revealed a significant difference between 11 and 20 and more than 21 years of experience. Strong negative correlation between compassion satisfaction and burnout whereas a moderate positive correlation between burnout and STS was observed. The study identifies factors such as occupation type and years of experience have an influence on the professional quality of life.

Evaluation of singing vocal health in Yakshagana singers

2016-25-07 Journal of Voice, 2017, Vol 31(2), Pg. 253 e13 – 253 e16 Gunjawate, D.R. Aithal, U.V. Devadas, U. Guddattu, V.

INTRODUCTION: Yakshagana, a popular traditional folk art from Karnataka, India, includes singing and dancing. Yakshagana singer or Bhagavata plays an important role in singing and conducting the performance. The present study aims to assess the singing vocal health using Singing Voice Handicap Index-10 (SVHI-10) in these singers and to compare between those who report voice problem and those who do not. METHOD: A cross-sectional study was carried out on 26 Bhagavata using demographic questionnaire and SVHI-10 in the Kannada language. Descriptive statistics was used to summarize the data. Independent sample t test was used to compare the responses for demographic variables between the two groups of singers with and without voice problems. The difference in scores of SVHI-10 between the two groups was analyzed using Pearson's chi-square test. RESULTS: Of the Bhagavata, 38% reported to have experienced voice problems, which affected their singing, with higher total SVHI-10 score (31.2 ± 5.7) compared with those who did not report any problems (16.81 ± 9.56). A statistically significant difference between the groups was noted in the emotional domain and total scores. CONCLUSION: The present study provides preliminary information on the voice handicap reported by Bhagavata. The singers reporting voice problems scored higher on SVHI-10. A healthy singing voice is essential for Yakshagana singers, and voice problems can have a significant impact on their performance and livelihood. Hence, results of the present study indicate the need to understand these singers' voice problems and their impact more comprehensively, and educate them about voice care.

Knowledge and attitude of parents/caregivers towards newborn hearing loss – A systematic review.

2016-15-10 International Journal of Audiology, 2016, Vol 55(12), Pg 715-722 Ravi R Gunjawate, D.R. Yerraguntla, K. Lewis, L.E. Rajashekhar, B.

Objective: The parents/caregivers of a newborn play a pivotal role in the process of hearing screening and intervention. The decisions taken by them depend on their knowledge and attitude. The purpose of this study was to review the literature systematically on knowledge and attitude of parents/caregivers towards infant hearing loss and newborn hearing screening. Design: A systematic search was conducted using electronic databases for the periods from 1990 to March 2016. Two authors scrutinized the studies and extracted the data based on predetermined criteria. Study sample: Ten studies. Results: Ear discharge was correctly identified as a risk factor for hearing loss along with measles, drugs/medication, family history, congenital causes and noise exposure. The studies revealed mixed results for knowledge about newborn hearing screening. Overall, the parents/caregivers showed positive attitudes towards hearing screening and intervention options. However, due to heterogeneity in the studies, it’s hard to derive a conclusion. Conclusions: The present review sheds light on the common areas of misconception among parents/caregivers about risk factors of infant hearing loss and newborn hearing screening. The review also draws attention to the need to have more studies exploring this knowledge and attitude of parents/caregivers among diverse populations.

Follow-up in newborn hearing screening – A systematic review

2016-27-08 International Journal of Pediatric Otorhinolaryngology, 2016, Vol 90, Pg 29-36 Ravi R Gunjawate, D.R. Yerraguntla, K. Lewis, L.E. Driscoll, C Rajashekhar, B.

Introduction: The quality and efficiency of newborn hearing screening programs (NHS) rely heavily on appropriate follow-up. The Joint Committee on Infant Hearing recommends a follow-up rate of more than 95% of infants who fail the initial hearing screening. However, a 70% benchmark is considered to be more feasible. This high loss to follow-up (LTF) rate acts as a threat to the overall success of NHS programs. The objective of the study was to identify and examine the reported rates of LTF, attributed reasons for LTF and strategies undertaken to reduce LTF. Methods: Using a systematic search, articles published between 2005 to December 2015 were identified from PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Ovid, ProQuest, and Cochrane Library. To be included in the review, the study should be exploring the loss to follow-up or drop-out rate in newborn hearing screening programs and be published in an indexed peer-reviewed journal in the English language. The main outcome measures were overall rate of LTF, factors leading to LTF and measures adopted to overcome LTF. Results: 53 articles were short-listed for data extraction. Out of these, 27 were single-centre studies, 19 were multi-centre, 3 compared multiple databases, and 4 used survey-based methods. Overall LTF rates of 20% in single-centre and 21% in multiple-centre studies were observed. Educational disparity and lack of adequate knowledge among parents were associated with LTF. The most commonly used strategy to overcome LTF suggested by studies was the use of an adequate data management system. Conclusion: This review is a novel attempt to explore the LTF among NHS studies, reasons for LTF and strategies to reduce LTF. This review can act as a basis for planning and execution of effective NHS programs.

Validation of Kannada version of the Singing Voice Handicap Index.

2016-29-11 Journal of Voice, 2017, Vol 31(4), Pg 507.e7-507 e11. Gunjawate, D.R. Aithal, U.V Guddattu, V. Rajashekhar, B.

OBJECTIVE: The present study aimed to adapt and validate the Singing Voice Handicap Index (SVHI) into Kannada language using standard procedures. STUDY DESIGN: This is a cross-sectional study. METHODS: The original English version of SVHI was translated into Kannada. It was administered on 106 Indian classical singers, of whom 22 complained of voice problems. Its internal consistency was determined using Cronbach's alpha coefficient (α), test-retest reliability using Pearson's product moment correlation and paired t test, and the difference in mean scores by independent sample t test. RESULTS: The results revealed that the Kannada SVHI exhibited an excellent internal consistency (α = 0.96) with a high item-to-total correlation. Further, excellent test-retest reliability (r = 0.99) and significant differences in SVHI scores were also obtained by singers with and without a voice problem (t = 12.93, df = 104, P = 0.005). CONCLUSION: The Kannada SVHI is a valid and reliable tool for self-reported assessment of singers with voice problems. It will provide a valuable insight into the singing-related voice problems as perceived by the singers themselves.

A national survey of knowledge, attitude, and practices among pediatricians toward newborn hearing screening In India.

2017-30-01 International Journal of Pediatric Otorhinolaryngology, 2017, Vol 95, Pg. 9-14 Ravi, R Gunjawate, D.R Yerraguntla, K. Lewis, L.E. Rajashekhar, B

INTRODUCTION: Pediatricians have a key role in ensuring that infant has undergone hearing screening and required follow-up. Attempts in various countries and centers have been made at exploring their knowledge, attitude and practices towards universal newborn hearing screening. In India, such a program is at its preliminary stage, and hence a need was felt to study this aspect in pediatricians working in India. METHOD: A cross-sectional online survey was carried out among 112 pediatricians working in India. The questionnaire was framed after reviewing the existing questionnaires. Descriptive statistics was used to summarize the findings. RESULTS: A response rate of 7.99% (112/1402) was obtained of which only 20.5% reported of availability of screening program in their work set-up. The majority of the pediatricians (95%) were aware of the newborn hearing screening while 98.3% were affirmative about the importance of screening of all infants. Very few pediatricians reported of a screening program in their set-up or in their close locality. Overall the pediatricians were confident about their knowledge on this topic yet expressed a need to know more about several intricacies about hearing screening. The pediatricians also provided an input on the most preferred method of receiving more information. SUMMARY AND CONCLUSION: The success of the universal newborn hearing screening program lies in the support and cooperation of health care providers such as pediatricians. The present study draws attention to the positive attitude and practices exhibited by them. It also sheds light on the knowledge gaps that are present and need the due attention of the policy makers. Further, it highlights the need for having more continuing medical education program and awareness drives for ensuring a better implementation of UNHS.

Speech language pathologist’s knowledge of genetics – An Indian perspective

2017-31-01 Online Journal of Health and Allied Sciences, 2017, 15 (4), 10. Ravi, R. Yerraguntla, K. Gunjawate, D.R. Ayas, M

Background and Objectives: The aim of the present study was to examine the knowledge, attitudes and confidence levels about genetics among speech-language pathologists (SLPs) working in India; and further to identify the relationship between knowledge, attitudes and confidence levels. Methods: A cross-sectional study design was implemented to carry out an email-based survey to assess the knowledge, attitudes and confidence levels about genetics among SLP’s in India. Results: Responses from 121 SLP’s working with pediatric population were analyzed. Results suggested that 70.3% of responses were correct for the genetic knowledge based questions. The confidence levels and attitudes were in the medium categories. The primary sources of learning were from school lesson as reported by the professionals. There existed a positive correlation between knowledge index and the mean attitude and confidence levels.Conclusion: The findings of the present study add valuable information to international literature and provides suggestions towards increasing more topics related genetics into the curricula.

Systematic review of knowledge of, attitudes towards, and practices for newborn hearing screening among healthcare professionals

2017-09-11 International Journal of Pediatric Otorhinolaryngology, 2017, 104, 138-144 Ravi, R. Dhanshree R Gunjawate Yerraguntla, K. Rajashekhar, B

Introduction -The success of newborn hearing screening programs lies in the timely identification, diagnosis, and management of children with hearing loss accomplished via a multidisciplinary newborn hearing screening (NHS) team. The team is typically comprised of various healthcare professionals who act as decision makers as well as facilitators for different stages in the screening process. Team members' knowledge of, attitudes towards, and practices for early hearing detection and intervention programs are critical for success and prevention of loss to follow up. In this context, it becomes crucial to understand their knowledge of, attitudes towards, and practices for towards newborn hearing screening. Methods - A systematic review was conducted on the following databases; PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, Science Direct and Cochrane Library. This search was carried out using various keywords such as practitioners, newborn hearing screening, knowledge, attitudes, and practices in different combinations. The review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines. Results - A total of 271 hits were obtained of which 20 articles were found suitable for inclusion in the final review. Overall, similar results were found regarding team members' knowledge of NHS programs, regardless of country of origin. Similarly, attitudes toward NHS programs were positive. Team members' experiences with NHS programs varied from country-to-country and across healthcare professionals. Results consistently showed gaps in team members' knowledge suggesting the need for outreach and professional education programs on NHS. Conclusion - NHS teams members from different countries, healthcare systems, and early hearing detection and intervention programs show gaps in critical knowledge warranting outreach and educational programs.

Acoustic Analysis of Voice in Singers: A Systematic Review

2018-22-01 Journal of Speech, Language, and Hearing Research, 2018, 61 (1), 40-51. Dhanshree R Gunjawate Ravi, R. Rajashekhar, B

PURPOSE: Singers are vocal athletes having specific demands from their voice and require special consideration during voice evaluation. Presently, there is a lack of standards for acoustic evaluation in them. The aim of the present study was to systematically review the available literature on the acoustic analysis of voice in singers. METHOD: A systematic review of studies on acoustic analysis of voice in singers (PubMed/MEDLINE, CINAHL, Scopus, ProQuest, Cochrane, Ovid, Science Direct, and Shodhganga) was carried out. Key words based on PIO (population-investigation-outcome) were used to develop search strings. Titles and abstracts were screened independently, and appropriate studies were read in full for data extraction. RESULTS: Of the 895 studies, 26 studies met the inclusion criteria. Great variability was noted in the instruments and task used. Different acoustic measures were employed, such as fundamental frequency, perturbation, cepstral, spectral, dysphonia severity index, singing power ratio, and so forth. CONCLUSION: Overall, a great heterogeneity was noted regarding population, tasks, instruments, and parameters. There is a lack of standardized criteria for the evaluation of singing voice. In order to implement acoustic analysis as a part of comprehensive voice evaluation exclusively for singers, there is a certain need for methodical sound studies.

Knowledge and perceptions of teleaudiology among audiologists: A systematic review

2018-03-05 Rohit Ravi Gunajwate, D.R Yerraguntla, K. Driscoll, C.

Journal of Audiology and Otology, 2018, 22 (3), 120-127



    “The greatest musical instrument given to a human being is the VOICE” – Swami Dayanand Saraswati As rightly said by Swami Dayanand Saraswati, indeed the human voice is the most complex yet beautiful instrument that we have been gifted with. It acts a mirror to our emotional states and well-being. Thus, in many instances we can identify the emotional state that a person is going through based on their voice; be in angry, sad, or terrified. Our voice holds a very important position in our lives which is often taken for granted. The World Voice Day is celebrated worldwide on April 16th to increase global awareness about voice, voice problems and remediation options. Several individuals are dependent on their voice for a source of living. Any individual whose voice is essential and a basic requirement of their job is called as an occupational/professional voice user. These include actors, singers, teachers, drama artists, salespersons, lawyers, priests, call center workers, etc. These professionals are at a great risk of developing a voice disorder due to heavy demands they place on their voice. Further, even a minor deviation in their voice can have a significant impact on them. Sadly, in most cases these individuals are unaware about their voice problems and consider voice change as a part and parcel of their job. They continue to overuse, misuse and abuse their voice for professional and social needs. Often they seek help from voice experts after a very long time since the onset of the problem. A voice disorder is said to exist when the voice quality, loudness or flexibility differs from other individuals of the same age, gender or profession. The causes of voice problem include over use, abuse or misuse of voice. The vocal abusive behaviors include behaviors which when used in excess can lead to vocal fold injury such as excessive talking, throat clearing, screaming, smoking and excessive coughing. Vocal misuse includes abnormal voice usage thereby causing injury to the vocal folds such as speaking loudly, singing at wrong pitch or loudness. Environmental factors include smoke, dehydration, fumes, pollution, allergic pathogens can also trigger voice problems. The other causes include infections, allergies, gastroesophageal reflux, hormonal disorders, cancerous and non- cancerous vocal fold lesions. If you or anyone you know is experiencing any of these symptoms; consult a speech language pathologist/voice therapist at the earliest: • Change in voice quality/hoarseness • Vocal fatigue/tiredness • Dryness in throat • Pain in throat • Sore throat • Weak voice or inability to speak at all • Voice breaks while speaking • Feeling of tightness in throat • Discomfort while speaking • Reduced pitch and loudness • Change in voice quality after prolonged speaking • Excessive effort needed to talk • Frequent desire to clear throat