One thousand consecutive patients seen in a multidisciplinary voice clinic are reviewed. The incidence and relative severity of diagnostic features in each of five assessment areas are calculated and compared. The five areas include: 1. history, 2. laryngoscopic examination, 3. perceptual-acoustic assessment, 4. voice related musculoskeletal, and 5. psychological evaluations. Feature prevalence is presented for patients we have classified as having muscular tension dysphonia, which can be primary, or associated with vocal nodules, chronic laryngitis, or polypoidal degeneration; or as having a psychogenic "functional" dysphonia. Following review of the data, we present a suggested list of diagnostic criteria that should be present before using a specific diagnostic label. These criteria have been further broken down into those that will be present to make a diagnosis, and those that may be present.

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The atlanto-occipital distance is the major factor which limits extension of the head on the neck. It varies widely in the population at large. When the posterior tubercle of the atlas is already in contact with the occiput in the neutral position, attempts to extend the head result in anterior bowing of the cervical spine, and forward displacement of the larynx. This may be a cause of difficult laryngoscopy.

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In 1981 a study was undertaken to determine intern and resident psychological well-being and identify those house staff who were psychologically impaired. Fourteen percent of house staff were found to be impaired. Single females and house staff who were chronically fatigued or socially isolated were at highest risk for impairment. Impairment arose out of the interaction between sleep and social deprivation and individual vulnerability. Minor tranquillizers, but not alcohol, were used as a coping response to impairment.