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62 reviewsDifficulty with the voice is often the first manifestation of systemic disease. Because of this, familiarity with laryngeal manifestation of systemic disease is important not only for otolaryngologists and phoniatrists, but also for family practitioners, internists, medical students, physician assistants, nurse practitioners, nurse clinicians, speech-language pathologists, singing voice specialists, acting voice specialists, voice teachers, and others entrusted with the care, education, and health of the human voice.