What do the terms psychogenic aphonia and psychogenic dysphonia mean?
The terms "psychogenic aphonia” and “psychogenic dysphonia” are used to refer to voice disorders where psychological factors usually cause sudden and significantly negative changes in voice quality (dysphonia), even extending to voice loss (aphonia).
This hoarseness or voicelessness frequently occur concurrent with an acute stress or conflict situation that the patients experience as extremely psychologically burdensome. Interestingly, the affected individuals are almost never aware of this fact themselves.
The presenting voice disorder is commonly misinterpreted by the patient as the result of "a cold”.
However, the conditions actually involved with psychogenic aphonia or psychogenic dysphonia are NOT psychiatric diseases. The patients are mentally healthy. They are merely coping with a pathological stress situation, similar to a stress-triggered asthma attack or gastrointestinal disorder.
What symptoms are caused by psychogenic aphonia and psychogenic dysphonia?
Psychogenic Aphonia
In psychogenic aphonia, the patient has usually experienced a sudden, dramatic voice loss. Although they want to speak resonantly, they can only manage a mere whisper. Striking are the almost always-preserved resonant cough and loud-sounding laugh. Simulation is virtually never the case.
During the videostroboscopic examination, the blockage of the vocal folds can be impressively observed when the patient tries a deliberate phonation. Moreover, normally, there are no pathological changes to be detected on the vocal folds.
Psychogenic Dysphonia
Psychogenic dysphonia tends to occur in a less sudden manner. Nevertheless, the patients can often describe the onset of symptoms very exactly. This voice disorder takes a more mild course and resembles the sound produced in a patient with hyperfunctional dysphonia where the voice production is typical strained and unstable
or – much rarer – in hypofunctional dysphonia with breathy, airy phonation. The videostroboscopic findings usually show the same symptoms as found in the respective functional voice disorders.
How are psychogenic aphonia and psychogenic dysphonia treated?
Psychogenic Aphonia
Psychogenic aphonia must be regarded as a “phoniatric emergency”. It is important to initiate treatment as fast as possible so that successful reinstatement of a resonant voice can be achieved during the first session. Treatment failures can lead to fixation of the disorder.
The therapy does not follow any pre-set treatment method. It is dictated by the examiner’s sensitivity and intuition as well as by the response of the patient to the different therapeutic approaches.
The primary strategy here is to first achieve an awareness for the pathological picture, then apply one of the various forms of vocal function exercise programs, acoustic masking as well as treating the laryngeal mucosa with local anesthetics.
Dr. Wohlt has achieved the most successful outcomes in patients with psychogenic aphonia by using suggestion treatment in combination with simple phonation maneuvers.
Psychogenic Dysphonia
Even for the experienced practitioner, psychogenic dysphonia is not always immediately diagnosable as a voice disorder of psychological origin. Its treatment usually entails a combination of vocal function therapy and adjuvant psychotherapy.
Given the frequently protracted course, there is always the possibility that symptom fixation occurs and organic lesions develop on the vocal folds, e.g. vocal cord nodules.
Case Report: Psychogenic Aphonia
A 26-year-old female journalist presented with voicelessness that had lasted 3 weeks. She reported waking up one morning in full health when suddenly she developed hoarseness bordering on aphonia that had not improved since then. Her ENT specialist expressed the suspicion of laryngitis that was treated with antibiotics—without any resolution so far.
The woman was a non-smoker. As a journalist, she was basically accustomed to above-average voice use: Over the last 3 months, however, after she changed jobs, a workplace related situation had developed in which her voice was less challenged, but where psychological conflicts ran rampant.
The video laryngoscopy showed primarily unremarkable vocal folds without any signs of inflammation.
During the stroboscopic examination, there was a blockage of adductor movement noted when she tried deliberate phonation. An impressively large, persistent gap was observed between the two vocal folds. Her voice was aphonic. A resonant cough, however, was possible.
Upon closer questioning, the woman admitted to having had a major fight with her boyfriend on the prior evening before the voicelessness became manifest. This event was additionally discomforting to her.
On that very same day, the patient was treated by the phoniatrician as part of an intensified suggestion therapy regimen accompanied by voice exercises. After a 30-minute treatment session, the woman had regained her resonant voice. A comprehensive consultation that made the patient aware of the interrelationships had resolved the situation.
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