A lack of awareness or perception of one’s personal vocal “volume level” to the point that it is creating difficulty in one’s life. If asked to place oneself on a personal loudness scale from 1 to 7, most individuals can do so with reasonable accurateness. Occasionally, however, an individual (with normal hearing ability) lacks this kind of self-insight, and such an individual could be said to have a disorder of vocal loudness perception.

At one end of this spectrum was a patient who was an operatic tenor. He had a powerful, almost head-rattling voice even in close quarters in a quiet room, and he was aware that others thought him loud, but he clearly could not “relate” to this. When coaxed and coached repeatedly to use a moderate voice to read a passage out loud, he quite sincerely (and loudly!) said, “Oh, I could never do that! That’s whispering!” At the other end of the spectrum, there was a 30-something woman with a voice one had to strain to hear. When she was coaxed and coached to read the same passage with a moderately loud voice, her utterly sincere but almost whispered reply? “Oh, I couldn’t talk like that. That’s yelling.”

Vocal loudness can vary between individuals considerably and still be accepted as “within normal limits.” Yet the two individuals described above were considered to have a disorder of vocal loudness perception because their inappropriate vocal loudness was exceptional enough to cause life difficulty. The man had considerable vocal cord injury, and the young woman was struggling at her job, with customers who were occasionally angry about the impossibility of hearing her. The approach was the same with both of these individuals: both were asked to retrain their “set point” for personal vocal loudness by recruiting other people (and their ears) to the re-training task.