Aphonia is a disorder of voice formation, in which the sonority of speech is lost. The patient can speak exclusively in a whisper; in the psychogenic form, loud laughter, coughing, and screaming persists. Possible pain in the throat, shortness of breath. Instrumental diagnostics of aphonia include endoscopy of the larynx (laryngoscopy, video stroboscopy), functional – psychological testing, speech therapy examination. Treatment is carried out with medications, physiotherapy, psychotherapy. Phonopedic lessons are shown. Sometimes surgery is required. Aphonia symptoms classification and causes
Aphonia, or headlessness (from the Greek “a” – without, “phone” – voice) is a complete loss of phonation ability with the preservation of whispering speech. Voice disorders in practical speech therapy are usually divided into functional and organic. According to various researchers, functional psychogenic aphonia is diagnosed 8-12 times more often in women. With regard to the organic form, statistical and epidemiological data are not presented in the literature. Both variants of the disease are found in children and adults.
Causes of aphonia
The complexity of etiofactors that cause voice disorder is diverse. Aphonia can be of psychogenic, neurogenic, neoplastic, infectious, allergic, post-traumatic origin. The main groups of reasons:
- Psycho-traumatic situations. Lead to the development of psychogenic aphonia. The disorder usually occurs in emotionally unbalanced women and girls in puberty, people suffering from hysterical nervousness, panic attacks, and severe emotional stress.
- Tumor processes. The cause of voice loss can be papillomas, angiomas, laryngeal cysts, singing nodules located directly in the vocal folds. Another probable mechanism of aphonia is associated with compression of the recurrent nerve by mediastinal tumors, a giant retrosternal goiter.
- Paralysis of the larynx. They can have a different genesis, be one- and two-sided. Aphonia often manifests against the background of diphtheria, bulbar dysarthria. Damage to the laryngeal nerve is possible with injuries of the larynx, including during surgical interventions – for example, during thyroidectomy.
- Narrowing of the glottis. It develops with laryngitis, laryngeal stenosis, foreign bodies entering the windpipe, laryngopharyngeal reflux. As a result of reflex spasm, swelling of folds, the presence of scars or mechanical obstacles, phonation, and respiration are disturbed.
- Dehydration. With severe dehydration with the loss of a large amount of fluid, the elasticity of the vocal folds decreases. Dysphonia and aphonia are accompanied by toxicosis in severe enteritis, cholera.
Symptoms of aphonia
For a patient with organic aphonia, only whispering is available. The voice is silent even with a cough reflex, in a state of emotional reactions. Depending on the underlying disease, there may be a sore throat, difficulty breathing, choking, and impaired swallowing.
The psychogenic form of aphonia develops suddenly immediately after a traumatic event or the next day after it. The voice is absent, while the ability to cough loudly, laugh, cry, and sometimes scream loudly remains. Patients additionally complain of a feeling of “sand”, “lump”, “accumulation of mucus” in the throat. General weakness, cardialgia, tremors in the body are possible. Patients do not trust doctors and exaggerate the severity of their disease. The voice can appear as suddenly as it disappeared.
According to the level of damage, organic and functional disorders of the voice are distinguished. In this case, long-term functional aphonia can turn into organic. Both forms can be of central or peripheral origin:
- True (laryngeal) aphonia – caused by diseases of the larynx and vocal folds (inflammation, swelling, trauma).
- Functional aphonia – caused by a violation of the reflex mechanisms of voice formation, overstrain of the vocal apparatus.
Taking into account the leading mechanism of phonatory disorder, spastic (associated with spasm of the laryngeal muscles and glottis) and paretic form of aphonia (caused by damage to the recurrent nerve) are distinguished.
Examination of patients with aphonia is carried out by pediatricians and speech therapists. In the psychogenic version, psychotherapists are involved in the diagnosis. Special instrumental studies and test methods are used:
- Laryngoscopy. The laryngoscopic picture in various forms of aphonia can be variable. Endoscopic examination reveals a gaping or spasm of the glottis, hyperemia, swelling of the vocal folds, the presence of neoplasms, foreign bodies, scars. The technique is informative for finding the causes of aphonia.
- Video stroboscopy. It is performed to assess the mobility of the vocal folds at the time of voice delivery. In the case of aphonia, there are no oscillatory movements of the folds, a violation of their closure is determined, the voice is not reproduced.
- Speech therapy examination. The phonopedist examines the qualitative characteristics of the voice and phonation respiration. He pays special attention to changing the voice in case of non-verbal reactions: coughing, laughing. Subjective acoustic assessment of the voice is carried out on a 5-point scale, where 5 points correspond to aphonia.
- Psychological testing. Required for patients with suspected hysterical aphonia. A number of questionnaires and tests are used to determine the psychotype of the personality, to identify the problems that led to the loss of voice. Aphonia symptoms classification and causes
Treatment of aphonia
In many cases, the first step towards voice restoration is the medical stage. With laryngitis, allergic laryngeal edema, drug treatment is carried out: endolaryngeal infusions, inhalations, antibacterial, antihistamine, homeopathic therapy. Removal of foreign bodies from the larynx is carried out under endoscopic control.
Treatment for paralysis of the larynx depends on their etiology. May require the appointment of nootropic, neuroprotective, vitamin, and other drugs. Methods of physiotherapy are effective: electrical stimulation, drug electrophoresis, acupuncture. With severe exicosis, infusion therapy is indicated.
Tumor processes of the larynx require nonsurgical intervention: removal of papillomatosis, coagulation, and destruction of neoplasms, chordectomy . With cicatricial stenosis, bougienage of the larynx is performed, followed by endoprosthetics or laryngoplasty.
Speech therapy work with aphonia begins with the appointment of complete vocal rest. Against this background, articulation and breathing exercises, vibration massage is performed. Then they move on to the formation of a soft voice supply with the help of phonation exercises. The sound intensity is gradually increased. At the same time, they are working on the development of the range, pitch, timbre of the voice. In phonopedic classes, modern technical means are used: voice amplifiers, computer simulators.
Patients with psychogenic aphonia are shown sessions of psychoanalysis, suggestion therapy. Autogenic training plays an important role. In severe cases, hypnotherapy is used. It also requires treatment for other disorders that can provoke aphonia. Faith in the success of voice restoration is essential. Aphonia symptoms classification and causes