“Psychogenic Aphonia”

Muhammad Wasif Haq Masters Speech Pathology

Definition

• “Voice disorders which have arisen

as a manifestation of psychological

disequilibrium such as anxiety,

depression, personality disorder or

conversion reaction, to the extent

that normal volitional control of the

phonation is lost”. (Baker, 2002) Deviantart.com

Prevalence • 4-5% of all voice

disorders.

• 8: 1 ratio for females to

males.

• Females:40 yrs mean

age.• (Baker, 2002)

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Case presentation

• “It is more important to

know what sort of a

person has a disease

than to know what sort of

a disease a person has”-

Hippocrates.

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Client’s Presentation• T, a 38 yrs old woman presented with sudden

voice loss.

• No organic lesion identified.

• Attended two sessions.

• Accompanied by mother.

• Introvert.

• Difficult to engage.Deviantart.com

Assessments & Findings

Assessments

Case history & medical notes

• Swallowing difficulties.

• Family history.

• Daughter in foster care.

• Wants to have another child

• History of depression.

• History of suicidal attempt.

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VHI-10 scores>11 indicates abnormality (Rosen, Lee, Osborne, Zullo, Murry,2004)

Voice perceptual characteristics

• S: Z ratio: 4:2 seconds or 2

• Maximum phonation time:

2 seconds for /a/ and /i/ sounds.

• Involuntary cough and throat clearing produced

short bursts of phonation.

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Stroboscopic Examination

Supraglottic constriction and increased mucous

deposition between vocal folds.

Diagnosis• Functional- Psychogenic voice disorder (Type 1)

• Breathy, strained voice, false vocal folds

constriction, sensation of lump in throat.

• No single feature diagnostic.

(Baker, 2008)

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It’s real and lasts longer than a dream

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Possible causes• Pattern of inhibition in expression

• Traumatic/ abusive events

• Introversion.

• Combating stress

• Feelings of helplessness

• Relationship problems

• Conflict over speaking out

• Low level of emotional awareness

(Baker, 2002)

Planetmusing.com

(Royal college of speech and language therapists, 2009)

Management

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Addressing the real issue

Keeping emotions under control is often a waste of energy.

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Conventional therapy• Vegetative voice functions.

• Inhalation on phonation

• Laryngeal massage & digital manipulation.

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Wherefrom here?• Goals dictated by assessment results and client’s

communication goals.

•

Initial management plan

Evidence support• Expert opinion vs randomized control trials. (Level

4) (Baker, 2002)

• Role of transcranial magnetic stimulation of motor

cortex. (Feinstein, 2009)

• Local anaesthesia. (Kollbrunner, Menet, Seifert, 2010)

Intervention planning

Deviantart.com

Principles & strategies

• Feedback and instructions.• Provide encouragement for every effort.• Involving mother in session plan activities.

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Missing connection

‘The lack of understanding, whether be real or imagined, can cause immense problems.’- Dr. Brian Roet

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Reflection & learning

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What I learnt by this case

• Extended role of a speech pathologist.

• Empathy vs sympathy (Lussier & Richard, 2010)

• Accommodate for set-backs, rather than feeling

emotionally demoralized.

• Case history questions.

• The choice of right words.

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Valuable tips• Allow patient to feel power & freedom to choose.

• Cultural differences.

• Importance of crying.

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Special thanks• Stephanie Martin- Clinical educator

• Janet Baker

• Elle Finos

References• Baker, J. (2002). Psychogenic voice disorders--heroes or hysterics? A brief overview with

questions and discussion. Logopedics Phonatrics Vocology, 27(2), 84-91.

• Baker, J. (2008). The role of psychogenic and psychosocial factors in the development of functional voice disorders. International journal of speech-language pathology, 10(4), 210-230.

• Feinstein, A. (2009). Psychogenic aphonia: spectacular recovery after motor cortex transcranial magnetic stimulation. Journal of Neurology, Neurosurgery & Psychiatry, 80(1), 4-4.

• Kollbrunner, J., Menet, A. D., & Seifert, E. (2010). Psychogenic aphonia: No fixation even after a lengthy period of aphonia. Swiss Medical Weekly, 140(1), 12.

• Lussier, M. T., & Richard, C. (2010). Should family physicians be empathetic? YES. Canadian Family Physician, 56(8), 740-742.

• Rosen, C. A., Lee, A. S., Osborne, J., Zullo, T., & Murry, T. (2004). Development and Validation of the Voice Handicap Index‐10. The Laryngoscope, 114(9), 1549-1556.

• Royal college of speech and language therapists. (2009). Resource manual for commissioning and planning services for SLN. Retrieved from http://www.rcslt.org/speech_and_language_therapy/commissioning/voice_plus_intro

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