Any physical condition that impairs the normal function of the abdominal muscles can be suspected as a cause of dysphonia. This, for example, occurs in pregnancy, or in the presence of a sprained ankle or a broken leg that require the use of an unusual posture to balance, modifying abdominal support and, potentially, causing voice dysfunction. Any neurological disorder that causes tremors, endocrine disorders such as thyroid dysfunction or menopause, the aging process, and other systemic conditions can alter the voice. It must always be remembered that anomalies of almost all body systems can cause vocal dysfunctions and therefore we must not stop at the evaluation of the head and neck.
As for the oral cavity, lymphoid hypertrophy associated with a scratchy voice and irritative cough can indicate a chronic infection. Bruxism is an indication of excessive tension and can be associated, for example, with a dysfunction of the TMJ (temporomandibular joint), a joint that should always be evaluated.
The examination of the neck should reveal the presence or absence of abnormal masses, excessive muscle tension (anterior or posterior), scars from previous surgical outcomes. Particular attention should be paid to the thyroid gland, every palpation and / or correction maneuver should always be respectful of this tissue. The evaluation of the vertical mobility of the larynx is fundamental as its inclination, due for example to the partial fixation of the muscles cut during a previous operation, can produce vocal dysfunction. An examination of the cranial nerves should always be included, particularly if there is a history of "cold sores". Finding a decrease in sensitivity of the 5th cranial nerve, deviation of the palate, or other cranial nerve deficits, even mild, may indicate mild cranial polyneuropathy, or more simply, entrapment or compression. Neuropathies from postviral infections can involve the superior laryngeal nerve and cause weakness, fatigue, and loss of vocal range. Debilitating conditions such as mononucleosis or chronic anemia can result in vocal fatigue.
Finally, it is essential to have in mind the cases of dysarthria and dysphonia characteristic of serious neurological diseases. A dysarthria is a defect in