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GRBAS (grade, roughness, breathiness, asthenia, strain) scale

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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assessment of patients with laryngeal symptoms

Patients should be assessed for airway patency. Presence of stridor or respiratory distress should prompt emergency referral to a facility where airway support can be provided quickly if needed.

Following airway assessment, patient history should cover:

  • the nature and chronology of voice symptoms
  • exacerbating and relieving factors
  • patient's voice use and requirement
  • presence of associated red flag symptoms
  • life style factors e.g. smoking, diet, hydration
  • effect on quality of life and psychosocial wellbeing

Investigations commonly include:

  • general head and neck examination - oral cavity, oropharynx, and neck
  • assessment of the patient's voice - can be done through
    • a simple scale:
      • grade 1 (subjectively normal voice),
      • grade 2 (mild dysphonia),
      • grade 3 (moderate dysphonia),
      • grade 4 (severe dysphonia),
      • and grade 5 (aphonic) plus use of additional qualifiers used as necessary - for example, breathy, strained

    • GRBAS (grade, roughness, breathiness, asthenia, strain) scale
      • grades hoarseness, roughness, breathiness, aesthenia (weakness), and strain on a scale of 0-3
        • 0 = normal, 1 = mild degree, 2 = moderate degree, and 3 = high degree (1).


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