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Aphonia by Mary Cresse

Definition

Aphonia is a condition that involves complete or partial loss of your voice. You cannot speak or can only whisper. This is usually due to problems with the voice box (called the larynx). There is treatment for this condition.

The Larynx

Causes

Aphonia can be caused by:

Physical conditions—may involve injury, inflammation, or disease, such as:
- Laryngeal or thyroid cancer
- Removal of larynx due to cancer
- Damage to the nerves that affect how the larynx functions
- Paralysis of the vocal chord
- Severe laryngitis (viral, bacterial, or fungal)
- Thickening of the vocal chords
- Nodules or polyps on the vocal chords
- Vocal abuse (eg, yelling or talking excessively, smoking , drinking a lot of alcohol or caffeine , being exposed to air pollutants)
- Breathing problems that affect the ability to speak
- Primary progressive aphasia (a form of dementia that affects the ability to communicate)
- Other neurological disorders (eg, myasthenia gravis , multiple sclerosis , Parkinson’s disease , amyotrophic lateral sclerosis )
- Injury to the laryngeal nerve after neck or chest surgery
Psychological conditions, such as:
- Hysterical aphonia (due to psychiatric causes)
- Selective mutism (symptom of an anxiety disorder)

Risk Factors

These factors increase your chance of developing aphonia:

Having surgery on or around the larynx
Overusing voice (eg, speaking until you are hoarse)
Having an anxiety disorder
Engaging in behaviors that abuse your vocal chords, such as smoking, which puts you at a higher risk for cancer of the larynx

Tell your doctor if you have any of these risk factors.

Symptoms

If you have any of these symptoms do not assume it is due to aphonia. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

Paralysis of vocal cords, either physical or psychological
Inability to speak or inability to speak above a whisper
Hoarseness
Spasm of vocal cords
Throat pain
Difficulty swallowing, food or fluids going into the lungs

Diagnosis

Your doctor will ask about your symptoms and medical history. She will also do a physical exam. If there is a clear link to a physical cause, aphonia can be easily diagnosed. It may be more difficult, though, if the condition is due to psychological causes.

You may be referred to a:

Laryngologist or ear, nose, and throat doctor (specializes in voice disorders)
Speech pathologist (specializes in speech and language disorders)
Neurologist (specializes in nervous system disorders)
Mental health professional

Treatment

Your doctor will work with you to create the right treatment plan. Treatment options include the following:

Voice therapy
Counseling (may include stress reduction and relaxation techniques )
Counseling combined with voice therapy
Surgery can help in some cases of aphonia
Alternative medicine (eg, electroacupuncture )

Your doctor will also treat the underlying condition. For example, if you have polyps or growths on your vocal chords, treatment may include:

Resting your voice
Learning a new speaking technique
Surgery (in rare cases)

Prevention

To help reduce your chance of getting aphonia, take the following steps:

Avoid abusing your vocal chords:
- Avoid talking excessively.
- If you smoke, quit .
- If you drink, do so in moderation.
- Limit the amount of caffeine you consume.
- Limit your exposure to fumes and toxins.
If you have to speak a lot for your job, learn proper vocal techniques from a voice therapist.
If you have anxiety, get help from a counselor.
Get treatment for underlying conditions.

RESOURCES:

American Speech-Language-Hearing Association http://www.asha.org/
National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/

CANADIAN RESOURCES:

Canadian Association of Speech Language Pathologists http://www.caslpa.ca/
Ontario Association of Speech-Language Pathologists and Audiologists http://www.osla.on.ca/

References:

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Casthely PA, Labagnara J. Hoarseness and vocal cord paralysis following coronary artery bypass surgery. J Cardiothorac Vasc Anesth . 1992;6:263-264.
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Stedman’s Medical Dictionary. 28th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005; 117.
Types of acute laryngitis. Voice Problems website. Available at: http://www.voiceproblem.org/disorders/laryngitis/types.asp . Accessed December 9, 2008.
Venes D, Thomas CL, Taber CW. Taber's Cyclopedic Medical Dictionary . Philadelphia, PA: FA Davis Co; 2001.
Vocal fold nodules and polyps. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/speech/disorders/NodulesPolyps.htm . Accessed November 5, 2008.
Vocal nodule. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 2008. Accessed November 5, 2008.
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Last reviewed December 2010 by Rimas Lukas, MD

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