Aphonia; is aphonia always a hysterical symptom?
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Aphasia↗
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A comparative study of psychological aspects of recurring and non-recurring functional aphonias.
The present study is based on the hypothesis that patients with recurrent attacks of aphonia differ from those with non-recurring attacks of aphonia in their anxiety levels, social assertiveness and stress-coping strategies. A comparison was made between 21 women with recurring aphonia and 19 women with non-recurring aphonia with respect to these three factors. Seventeen healthy women served as volunteers. Compared to patients with non-recurring aphonias, patients with recurring aphonias exhibited a significantly higher level of anxiety and significantly more respect for social norms and codes of propriety. Their coping was also characterized by a higher escape tendency. Patients with recurring aphonias also reported a significantly higher number of problems in their private lives within the preceding 5-year period. In therapy patients should be encouraged to reflect upon a possible rigidity toward social norms and better understand fears regarding conflicts in personal relationships.
Adaptation, Psychological↗
[Psychogenic aphonia; an effective and rapidly treatable conversion].
Psychogenic aphonia is a conversion symptom which is quite annoying to the patient. This article concentrates on the treatment of psychogenic aphonia. The literature contains only few articles on this subject. We present in detail a very efficient way of treatment with directive and biofeedback aspects. Central to the treatment is a direct approach of the symptom, based on the idea that due to the time factor the aphonia has become dissociated from the unconscious psychological conflict. The treatment starts with a double cough so that the vocal chords close. At the same time the ear, nose and throat specialist looks with the laryngoscope and corrects directly which gives an optimal learning effect. In 1988 and 1989, 23 patients were treated with this method. The duration of the aphonia varied from two weeks to two years. In eight of the patients the aphonia recurred. Patients were treated for a total of 45 episodes of aphonia. In all cases the voice returned within an hour.
Aphonia↗
[Diagnosis and treatment and prevention of iatrogenic functional aphonia].
OBJECTIVE: To discuss the diagnosis, treatment and prevention of iatrogenic functional aphonia. METHODS: Twenty three patients who either lost their voice or only could whisper after surgery in other hospitals were included in this study as the first group, history was well collected and laryngostroboscopy performed. All cases were confirmed as iatrogenic functional aphonia patients and received phonation therapy. In another group of patients who received vocal cord surgery in our hospital from 2003 to 2005, speaking was restricted while not prohibited after surgery, voice quality was closely observed, and 1028 cases were included. RESULTS: All 23 cases of functional aphonia were cured with phonation therapy. No iatrogenic functional aphonia occurred in the second group of patients. CONCLUSIONS: The iatrogenic functional aphonia can be caused by post operative mistreatment and could be cured with phonation therapy, and it is preventable if speaking is not strictly prohibited after surgery.
Adult↗
Sudden onset aphonia caused by a Japanese-style bath.
An 86-year-old man was referred by his family physician to our clinic because of sudden onset aphonia immediately after a Japanese-style bath. On examination, the only abnormality was aphonia, with an otherwise normal physical examination. However, we found vocal fold oedema on laryngeal fibrescopy. For treatment, he was immediately given 30 mg prednisolone intravenously. Twelve hours after injection the oedema had completely disappeared and his aphonia had resolved. The patient was healthy for three months after returning home. However, at the beginning of a cold winter night he again complained of sudden onset hoarseness, after taking a Japanese-style bath. Japanese-style baths are completely different from Western-style baths. There is a temperature difference of almost 30 degrees C between the inside and outside of a bath; the transition may represent a type of physical exercise in elderly and exhausted individuals. This difference could cause a cold or heat-induced allergic reaction. We strongly recommend a laryngeal study in case of sudden onset aphonia.
Aged↗
Psychogenic aphonia masking mutational falsetto.
Aphonia, originally due to laryngeal inflammation, became psychogenic and superimposed on the unstable pitch of adolescent voice change. We presumed that the aphonia was adopted as a means of dealing with peer pressure to maintain a high preadolescent pitch as well. Voice therapy was effective in alleviating both the aphonia and mutational falsetto. Clinicians should be alert to underlying mutational falsetto when confronted with an aphonic or dysphonic adolescent patient with no organic laryngeal pathologic condition.
Adolescent↗
[The treatment of psychogenic aphonia in two adolescents (author's transl)].
Psychogenic aphonia is rare in childhood and adolescence and its management is therefore problematic. Two examples, one of a hypofunctional aphonia in a 14 year old with a stutter and another of psychogenic aphonia confirm the necessity after psychiatric assessment and treatment of speech therapy in order to restore the voice to normal. The place of the laryngologist and speech therapist is discussed.
Adolescent↗
Arytenoid adduction and type I thyroplasty in the treatment of aphonia.
Arytenoid adduction is a procedure used to medialize the paralyzed vocal fold, closing the posterior glottis. Isshiki type I thyroplasty allows medialization of the anterior membranous vocal fold. Using the arytenoid adduction, in combination with Isshiki type I thyroplasty as needed, five patients were treated for aphonia. Surgical results were evaluated with voice recordings, electroglottography, and photoglottography. Jitter ratio, shimmer ratio, and signal-to-noise ratio were measured. Laryngeal stroboscopy and glottography were used to assess the mucosal wave and vibratory nature of the vocal folds. After operation, vocal function was restored. Analysis of data from these five aphonia patients revealed improved glottic phonatory function. The arytenoid adduction in combination with the Isshiki type I thyroplasty is an effective technique for aphonia caused by a significant posterior glottic gap with unilateral vocal-cord paralysis.
Arytenoid Cartilage↗
Aphonia due to paramedian thalamo-subthalamic infarction. Remarks on two cases.
We describe two patients in whom CT brain scans imaged paramedian thalamo-subthalamic infarcts in the territory of the thalamo-mesencephalic arteries. Such infarcts give rise to a complex syndrome marked by disturbances of consciousness and of eye movement and neuropsychological disorders, including attentional, memory and, more rarely, language deficits. A loss of voice volume may accompany aphasic disturbances but is exceedingly rare in isolation. In the cases described the aphonia, total but transient, was the only language disorder. The physiopathological mechanisms involved in aphonia are complex and controversial.
Aged↗
Cough offset schwa as a means of eliciting initial phonation in functional aphonia: two case reports.
The use of the schwa vowel at cough offset is an automatic production that can be easily prolonged and modified as a phonation-producing device without requesting initial voluntary phonation on the part of the patient. It is presented as a clinical method that was successful for the author with two female patients presenting functional aphonia. The technique lends support to the suggestions by Aronson (1969) and Boone (1971) that the symptomatic approach can be successful with the functional aphonic patient. The clinician should be mindful of the fact that in certain cases of functional aphonia an appropriate referral might be needed to deal with emotional aspects after voice is regained.
Adult↗
Aphonia as the only speech disturbance from bilateral paramedian thalamic infarction.
We examined a 55-year-old right-handed woman showing transient coma, amnesia, mild right hemiparesis, vertical gaze impairment and aphonia without aphasia. CT-scanning revealed bilateral paramedian thalamic infarction in the territory of the thalamo-subthalamic paramedian arteries. Aphonia may occur as a consequence of thalamic lesions, but until now it has not been described as an isolated speech disturbance.
Amnesia↗
Functional aphonia. A conversion symptom as defensive mechanism against anxiety.
Aphonia is the extreme form of a functional voice disorder. 22 female patients with aphonia underwent laryngoscopic and phonic examinations, psychiatric evaluation, psychological testing and biographical history-taking. Results demonstrate a homogeneous clinical picture, but heterogeneous personality structures and conflict situations. All patients are overtaxed by their situation; the conversion reaction is used as a means to express anxiety and maintain self-assertion at the same time.
Adult↗
[Cognitive-behavioral therapy of conversion aphonia].
Although a common disease, conversion disorder still calls attention in the clinical practice. A case of conversion disorder, diagnosed as a psychogenic aphonia that persisted for a week, was reported in this paper. A 21-year-old woman developed symptoms after breaking off a long-lasting relationship with her boy-friend. History revealed that she was introvert with high neuroticism and communication problems. Cognitive-behavioral therapy was used. After the positive reinforcement in the therapy of her aphonia, assertion training for the development of communication skills was performed. In the end, cognitive restructuring was used to prevent relapse in regard to her actual life situation of being a refugee preparing for immigration to Australia.
Adult↗
[Management and therapy in functional aphonia: analysis of 500 cases].
INTRODUCTION: The article reviews current opinions on etiopathogenesis and management of functional total loss of the ability to produce loud voice. Psychogenic aphonia refers to involuntary whispering despite a basically normal larynx. MATERIAL AND METHODS: [corrected] The longitudinal study was carried out on 500 patients treated for psychogenic aphonia during 32 years (1972-2004). Of the facilitating techniques, the following were useful for phoniatric therapy: relaxation and respiration, gargle, chewing, pushing, inhalation phonation, masking, phonetic exercises. RESULTS: During the first day of vocal exercises the voice return to 410 patients (82%). The others required carrying on vocal therapy. CONCLUSIONS: The basic importance of phoniatric therapy is recovering the voice during the first day of vocal exercises. Sometimes the aphonic patient profits most from symptomatic voice therapy concurrent with psychotherapy.
Adolescent↗
Use of the Lombard response in cases of hysterical aphonia.
Lombard is best known for his work on the effect of noise on vocal intensity. In 1917, he applied this concept to the treatment of hysterical aphonia and described the procedure he used in a military publication. He suggested that a masking noise will interfere with the auditory monitoring system sufficiently that the patient will not be aware he has regained use of phonation. Removal of the noise from the patient's ears confirms the return of phonation, and the aphonia disappears. Credit is given to Lombard for this pioneering effort, and suggestions for present-day clinical use are made.
Conversion Disorder↗
Visual feedback of vocal intensity in the treatment of hysterical aphonia.
This case report describes the successful though temporary removal of a hysterical aphonic symptom in a 49-year-old male patient by using visual feedback of changes in vocal intensity. Following symptom removal the patient experienced considerable emotional distress due to a number of factors. His aphonia returned and has proven resistant to subsequent intervention. At a 1-year follow-up his condition was found to be unchanged. The case is discussed in relation to the common controversy over the wisdom of symptomatic treatment for hysterical reactions, and a practical means of resolving the disagreement is considered.
Aphonia↗
Bulbar symptoms and episodic aphonia associated with atlanto-occipital subluxation in ankylosing spondylitis.
A patient with intermittent aphonia associated with atlanto-occipital subluxation due to ankylosing spondylitis is presented and discussed. The only other case from the literature is reviewed and compared with our patient, where symptoms and signs of episodic low bulbar disease, presumably due to intermittent vascular insufficiency, were relieved by external bracing.
Aphonia↗
Treatment of hysterical aphonia with hypnosis and prokaletic therapy.
A patient with chronic refractory hysterical aphonia was treated by prokalesis (challenge) and hypnosis within a psychotherapeutic relationship. A temporary remission was achieved but this was followed by subsequent relapse. This report illustrates the therapeutic effectiveness of prokaletic techniques. It also emphasises that these potent interventions are unlikely to achieve abiding change unless they are applied within the context of a longer-term relationship with a clinical team.
Adult↗