Dysphonia

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Classification according to ICD-10
R49.0 Dysphonia
ICD-10 online (WHO version 2019)

Dysphonia ( voice disorder ) is an impairment of the vocal part of the articulation (also called phonation ) in diseases or functional disorders of the larynx and the attachment tube .

The voice sounds hoarse, rough, thick or breathy, depending on the findings and characteristics. The voice is often no longer "flexible". The tone color, pitch and volume can then often only be varied to a lesser extent by the person concerned. The speaker then feels uncomfortable, feels a feeling of dryness or a foreign body / lump sensation in the throat and often compulsively clears his throat. This increased voice pressure increases the voice impairment. The maximum form is voicelessness ( aphonia ).

With permanent overuse, there is a risk of secondary organic changes, such as vocal cord nodules .

causes

Voice disorders can have organic and functional causes. Organic causes are e.g. B. inflammation , paralysis , benign and malignant neoplasms (e.g. polyps , nodules , granulomas , larynx cancer ), but also gastric acid reflux ( laryngitis gastrica ). In rare cases there are larynx injuries or congenital malformations of the larynx.

The functional dysphonia can have its origin in an overload ( ponogenic dysphonia , from gr. Ponos = work), in voice-damaging speech habits ( habitual dysphonia ), a constitutional weak vocal apparatus ( constitutional dysphonia ) and a type of conversion neurosis ( psychogenic dysphonia , also hysterical dysphonia ) and as a symptom of a general physical illness ( symptomatic dysphonia ). Depending on the clinical manifestation, a distinction is made between hyper- and hypofunctional dysphonia (“too much” or “too little” effort).

Voice changes also occur with hormonal changes, during the female cycle , but also during puberty or menopause , and are normal to a certain extent. Medicines can also cause voice disorders as a side effect in different ways, e.g. B. by drying out the mucous membranes with neuroleptics (systemic effect by reducing saliva / mucus production) or with asthma sprays (local drying out by the spray).

"Special" shapes

The following "special" forms of dysphonia are described in older literature:

  • Dysphonia clericorum in speakers ( e.g. preachers ), as a result of overuse of the voice, usually painful.
  • Dysphonia paralytica with damage to the vagus nerve or its branch laryngeal nerve (mostly inf.) [N. recurrens] .
  • Dysphonia puberum during the voice break .
  • Dysphonia spastica ( Aphonia spastica or Mogiphonie ): pressed, choppy, creaking voice caused by pressing together the vocal folds and the pocket folds when attempting phonation, especially with speakers or as a neurotic symptom (to be differentiated from spasmodic dysphonia , a form of dystonia ).
  • Dysphonia senilis : the voice of old age.

Diagnosis

The comprehensive medical diagnosis always includes laryngoscopy ( endoscopy of the larynx) with stroboscopy or high-speed camera and an auditory voice test for the speaking and singing voice. This is supplemented by the device-based recording of electrophysiological parameters such as basic frequency , jitter , shimmer, etc., by electroglottography and the creation of a voice field.

therapy

Functional voice disorders are usually treated in a targeted voice therapy with phoniatrists , breathing, speech and voice teachers or speech therapists ( e.g. phonation adapted to the rhythm of breathing ) by adjusting to the physiological vocalization. In the case of organic voice disorders, depending on the findings, surgical procedures are usually used, in which the changes are removed under general or local anesthesia (see phonosurgery ). Malignant changes usually require a generous removal of the tumor, which often results in permanent voice disturbance.

See also

literature