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Psychogenic Voice Disorders Global Journal of Otolaryngology ISSN 2474-7556 Powerpoint presentation Glob J Otolaryngol - Special Issue March 2017 Copyright © All rights are reserved by Lalsa Shilpa Perepa DOI: 10.19080/GJO.2017.05.555663 Psychogenic Voice Disorders Introduction are capable of adduction and there is no structural abnormality a) Voice disorders result from faulty structure or but the voice is abnormal. function somewhere in the vocal tract, in the processes of respiration, phonation, or resonance. c) In cases where there is coexisting laryngeal pathology, emotional state of the individual. the d)voice Themay presentation be much worse is notthan always the appearance consistent. suggests. A normal b) The normal voice and vocal tract reflect the changing of the autonomic system and of the personality that result in vocal note might be heard on vegetative behaviors such as c) Psychological states associated with disturbances coughing, throat clearing, yawning or laughing, but not when the voice is being used for communication. Definitionvoice disorders called Psychogenic voice disorders. e) During conversation the voice varies according to disequilibrium that interfere with normal volitional control social context, subject matter and the mood of the patient. a) “A manifestation of one or more types of psychologic with any known condition. over phonation” Aronson, A.E. (1990) f) The history and presentation might be inconsistent b) “Psychogenic Voice Disorder occurs in the absence g) Various therapeutic approaches can produce normal of structural or neurological pathology sufficient to account voice - fleeting and almost immediate recovery. or aphonia is interspersed with periods of normal voice. for the voice difficulty, with onset and maintenance of the (Baker, Ben-Tovim, et al. 2007) h) The voice disorder might be episodic. Abnormal voice voice difficulty caused by disturbed psychological processes.” i) The patient describes, or the history reveals, related or psychosomatic voice disorder a) Also sometimes referred to as non-organic, functional Etiologystressful events or prolonged stress. b) More in women (ratio of around 8:1) disorders are frequently multifactorial, and mainly they are a) Anderson and Schalen; 1998 - Psychogenic voice c) Sudden voice loss (rather than gradual onset) the result of psychosocial stress and triggered by emotional d) Generally identifiable psychological stress conflicts. Symptomscontributing to onset b) Inability or reluctance to express emotion is a a) Many of the symptoms are similar to those patients result, the individual retain a tense, stoic countenance. with muscle tension dysphonias. common feature in psychogenic voice disorders and, as a c) Butcher et al. (1987) found that the stressful situations b) The voice is frequently effortful to produce and the tract discomfort. for these patients could be classified into three groups patients describes vocal fatigue and, in many instances, vocal d) e) FamilyBurden and of responsibility Interpersonal difficulties f) Stressful factors associated with work c) The reaction might be excessive for the severity of the presenting problem or remarkably understated where far greater concern and distress would be more realistic in the Signslight of significant impairment. g) Anderson and Schalen (1998), in their study of the etiology of psychogenic voice disorders, confirmed the importance of family and work stresses as a major contributory a) The signs and symptoms are inconsistent with the factors. Rather than a specific life event acting as a trigger, clinical examination. their subjects reveal that the long term effects of conflicts and frustrations finally give rise to the problem. b) The laryngeal findings - normal phonation. i.e. VF’s Glob J Otolaryngol 5(3): GJO.MS.ID.555663 (2017) 0084 Global Journal of Otolaryngology f) The conversion symptom is not evidence of h) They concluded that psychogenic voice disorders Psychogenicindicated disturbed Voice capacity Disorders for emotional expression. malingering because it is not produced consciously or for intentionalSymptoms advantage or avoidance. a) The patient reports complete loss of voice of sudden b) Puberphonia a) Psychogenic aphonia onset, sometimes after an upper respiratory tract infection. b) Some patients describe a history of aphonic episodes c) d) PsychogenicChildlike/infantile Spasmodic speech Dysphonia in adults e) Immature voice in women of increase in frequency and duration, where as others find that they have no voice on waking one morning. A. Psychogenic aphonia sensation. Typically, the patient does not associate the problem c) The lack of voice may be accompanied by globus with emotional issues. i. Total loss of voice in the absence of organic pathology. Signs ii. Patients presenting with Psychogenic aphonia can be a) There is no vocal tract structural abnormality or any divideda) intoStress two related groups. aphonia b) Conversion symptom aphonia neuropathology.b) Sudden onset and in some cases there is a history of episodes of aphonia interspersed with periods of normal voice Stress - related Aphonia c) Voice can be elicited almost immediately by a) The majority of patients become aphonic because of appropriateSpecific techniques strategies in many cases prolongedb) Most stress of these and so patients produce are stress women related who usuallyaphonia. present Conversion symptom aphonia as tense, anxious and distressed by their aphonia. c) Prognosis is good in patients who are able to develop a) Explanation that the vocal tract and vocal fold Thompson, 1999. insight into psychosomatic basis of aphonia - Harris and movementb) The are patient particularly is reassured responsive that to thereemotional is no changes. physical reason why voice cannot be produced, apart from an element of aphonia, stress related aphonia is not necessarily a symptom d) Although this group has the symptom of non-organic habit,Facilitating and the therapisttechniques introduces strategies of eliciting voice. has become intolerable. of underlying psychiatric illness. It is an indication that stress Conversion symptom aphonia musculature. Manual techniques to reduce tension of the laryngeal a) A Conversion symptom is a physical symptom that occurs in the presence of normal physical structure and potentially normal function of the body involved. a) Vegetative techniques b) It differs from psychosomatic symptoms that are the b) Vocal function exercises reaction of the autonomic system to stress. B. Psychogenicc) Counseling Spasmodic Dysphonia symptom, the physical symptom concerns the somatic nervous c) In the individual suffering from a conversion a) Even though spasmodic dysphonia (SD) is a focal laryngeal dystonia of neurological origin there are some system, although it appears to be involuntary and is outside psychogenicb) In manifestations,origins too. the spasmodic adduction and the patient’s control. interferes with phonation. d) It is essentially a psychogenic illness with a unaware. abduction of the vocal folds during phonation dramatically characteristic motive of gain of which the individual is e) No voice is produced in conversion symptom aphonia, spasms, is more common than the involuntary voiceless c) The adductor form, resulting in effortful laryngeal other functions. although the vocal folds adduct and behave normally during segments of the abductor type. d) Emotional elements are significant in both conditions. 0085 How to cite this article: Lalsa Shilpa P, Psychogenic Voice Disorders. Glob J Oto 2017; 5(3): 555663. DOI: 10.19080/GJO.2017.05.555663 Global Journal of Otolaryngology e) Aronson (1918) established that 40 % of the patients h) However the full growth is usually completed by 21 of the condition. he examined have experienced emotional trauma before onset years of age. Typically, male voices drop by one octave, so by age 18, the average fundamental frequency is 130-140 Hz. similar to those of conversion symptoms. f) In psychogenic SD, the psychodynamics appears to be i) The longer and thicker the vocal cords the lower the pitch and a longer vocal fold means a deeper voice, which is why males tend to have deeper voice than girls. g) Trial voice therapy that resolves the condition males. Perhaps the most visible difference is the development confirmsC. Mutational the tentative falsetto/Puberphonia diagnosis (Damste, 1983). j) All the vocal tract changes are more apparent in voice of prepuberscence and to substitute the lower pitched of “Adam’s Apple”,which becomes more pronounced when the a) It is the failure to eliminate the higher pitched voice of postpuberscence and adulthood in the presence of a angle of the male thyroid prominence has decreased to an angle of nearer 90 degrees. In comparison , the female thyroid cartilage remains at an angle of approximately 120 degrees. structurally normal larynx. k) The growth spurt in puberty includes changes to b) Because the amount of vocal pitch change that 4 semitones in females, mutational falsetto is a voice problem both bones and muscles, again, males tend to have the greater occurs at puberty is about one octave for males and only 3 to found primarily in postpubescent and adult males. increase in the length of their bones and in muscle size and strength (Andrews and Summers,1991). and completion of dental development add to the overall normal lower pitch of adult males. l) Growth of the facial structures, including the sinuses c) The larynx is perfectly capable of producing the capacity for loudness and resonance. increase in size and
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