Hoarseness is a frequent complaint bringing patients to see the otolaryngologist, yet often the physical exam is unremarkable. Too often GERD related laryngitis is diagnosed, but the patient does not improve. Due to the multi-faceted nature of hoarseness, a deeper understanding of the causes of dysphonia is essential. Specific entities that will be highlighted include muscle tension dysphonia, vocal fold tremor, presbylarynges, spasmodic dysphonia, amyotrophic lateral sclerosis, and Parkinson's disease. Using numerous patient videos, we will demonstrate a diagnostic protocol that is straight forward and inexpensive that will allow the clinician to sort out these various etiologies of dysphonia. Emphasis will be placed on characterizing the perceptual nature of the hoarseness, recognizing physical exam hallmarks of each type of dysphonia, and being able to take patients through a variety of vocal tasks that will help make the diagnosis. Vocal tasks include sustained vowel sounds, number counting, and standardized sentences weighted in voiced and voiceless sounds. This course will be especially helpful for comprehensive otolaryngologists and will enhance their diagnostic abilities in the clinical diagnosis of hoarseness.