Greene & Mathieson's The Voice and Its Disorders, by Lesley Mathieson. London and Philadelphia: Whurr Publishers, 2001. 750 pages, $48.95.

The first edition of The Voice and Its Disorders by Margaret C.L. Greene was published in 1957. It represented a major contribution to the clinical assessment and treatment of voice disorders and was certainly among the few texts on the subject available at that time. In a subsequent edition, Greene introduced a collaborator in Lesley Mathieson. Mathieson has inherited the mantle of Greene's formidable work and is the sole author of the sixth edition.

Mathieson is a Visiting Lecturer in Voice Pathology at the University of Reading in Great Britain. A critical underpinning of her approach is the model provided by the voice pathologist's own vocal skills. She contends that the clinician must possess the ability to achieve and to control a variety of vocal behaviors to realize what is needed to improve voice output in the patients. Imaging techniques have made dramatic advances but the knowledge and experience of capable and compassionate clinicians remain paramount in the delivery of services.

The book is divided into three sections: Normal Voice, Voice Pathology, and Voice Therapy. Within each section are a number of chapters, each of which concludes with a clear summary. Additional features include a phonetic symbol chart, the "Rainbow Passage," sample case history and voice protocols, self-rating scales, and a list of support organizations and manufacturers both in the United Kingdom and the United States. References are found at the end of the book rather than after each chapter. The typeset is exceptionally reader-friendly. Case histories are clearly distinguished in gray and black and are scattered throughout the book where appropriate. The figures and charts are clear but several of the photographs are not. Color plates of laryngeal pathologies would have made a fine addition, although the reviewer is well aware of the economics of publication and the consideration of student and clinician finances. In fact, the relative low cost of the text is a positive feature.

Many of the cutting-edge conditions of modern life that result in the need for voice therapy are addressed. There are sections on laryngeal damage resulting from traffic accidents, chemical burns, intubation injuries, cannabis and anabolic steroid use, asthma, gastroesophageal reflux disease, and AIDS. Voice therapy after gender reassignment surgery is well-described. Vocal hygiene for professional singers is also covered.

The section on therapy calls for the development of a rational hypothesis as to the cause or causes of the voice disorder. Indeed, this reviewer expects a carefully written rationale for specific intervention methods for every clinical interaction, no matter what the disorder!! The book has several lists and discussions of the reasons for lack of progress and for discharge from therapy. These are especially helpful for the clinician confronted with the need to make difficult clinical decisions.

A chapter on intervention techniques presents both general and specific therapy methods for a range of voice disorders. A subsequent chapter deals with remediation of problems in children, the elderly, and professional vocalists. The final chapter of the book is devoted to laryngeal cancer and addresses many clinical procedures and pitfalls.

In summary, this new edition of an esteemed classic competes admirably with a number of general texts on voice disorders. It is suggested that a future revision give more detail on fibroscopic analysis, which many speech-language pathologists now perform routinely in both evaluation and in therapy. The exciting prospects of laryngeal transplantation need to be addressed. New strides in chemotherapy for laryngeal cancer warrant mention. The seventh edition would benefit from an author index. In addition, text citations would make more sense if past tense were used consistently (e.g., stated, reported), because references are usually old news by the time they are cited.

The 750 pages make the book heavy to carry, but, thanks to the clarity of presentation, the numerous tables, case notes and summaries, and the scope of information, The Voice and Its Disorders is a worthy and important book for students and clinicians.