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Psychogenic voice disorders (Puberphonia (Pathophys (Normal male adult…
Psychogenic voice disorders
Conversion voice disorders
What
Total, partial loss phonation bcos conversion rxn-manifestation of stress, depression, anxiety
Normal VF mvm, VF abduction on inspiration, VF adduction on cough/throat clear
When voicing attempted, VF mvm irregular, VF X adduct enough to create vibration
Person X convinced that it might be in their mind
Types
Conversion muteness
What?
most extreme, incapacitating
no whisper
Involuntary, voluntary cough present--> normal VF fn
Speaker has chronic stress, primary gain (bcos X talk) relieves them of stressful responsibility that they X fulfill, secondary gain (bcos X talk, less financial stressed), supressed anger, neurotic
Conversion aphonia
What?
involuntary whispering
able to do all reflexive actions: cough, laugh, cry --> normal VF
Larynx high in neck, is stiff
80% females
Onset sudden or over hours --> might be bcos traumatic event associated w severe stress
Hoarseness--> whisper
Can be triggered by colds--> persists--> converts to aphonia
Conversion dysphonia
What?
Varying degrees, types of hoarseness
+/- strained, harsh quality
High pitched falsetto breaks
Breathiness
Intermittent whispering (Inconsistent)
Moments of normal voice (Inconsistent)
Pain in neck area, external laryngeal muscle tightness when trying to phonate
Tx methods
Principle goal=re-establish normal VF fn by reshaping vegetative vocal fns
Aim to achieve good voice
Adopt positive attitude w person
Focus on voice production NOT the cause of the problem
Rmb to rule out physical causes w ENT first
Consider referral to psych
Puberphonia
What?
X eliminate high pitched voice associated w puberty, X subst w lower voice of adulthood
can also be in females
Aetiology
Strong feelings towards feminine attachment (male identity problems)
X wanting to be an adult
Organic
Endocrine disorders
Severe hearing loss
Disease affecting respiration eg. motor neuron disease
Pathophys
Normal male adult size larynx, laryngeal fn is abnormal
Larynx positioned high in neck, tilted downwards
VF lax
Phonation: arytenoids adduct tightly, posterior part VF X vibrate
Thyroarytenoid muscle X contract --> Decreased VF mass, only thin edge of VF vibrates
Mgm
Medical
If voice Tx fails, vocal fold augmentation is possible
If bcos psychologic cause eg. endocrine disorder/neurological condition, medication may be prescribed
Therapy
Principle goal=shape vegetative vocal production--> normal voice
Prognosis is excellent