Aphonia
(Aphonia; Partial Loss of Voice; Voice, Loss of; Voice; Partial Loss of)
Definition
Loss of voice (also called aphonia) may take several different forms. You may have a partial loss of your voice (such as mild hoarseness). Or, you may have complete loss of your voice. (For example, your voice sounds like a whisper.) Loss of voice can come on gradually or rapidly depending on the cause. It is usually due to problems with the voice box (called the larynx). However, there can be other causes.
Aphonia is different than aphasia, which is a communication disorder.
The Larynx
Causes
Aphonia can be caused by:
-
Physical conditions affecting the vocal cords or airway. This may involve injury, inflammation, or disease, such as:
- Laryngitis caused by a viral, bacterial, or fungal infection
- Vocal abuse (yelling or talking excessively)
- Exposure to airborne irritants, such as smoking or being exposed to air pollutants
- Acid reflux (eg, heartburn)
- Thickening of the vocal chords
- Nodules or polyps on the vocal chords
- Muscle tension dysphonia
- Damage to the nerves that affect how the larynx functions
- Laryngeal or thyroid cancer
- Removal of larynx due to cancer
- Breathing problems that affect the ability to speak
- Neurological disorders (eg, myasthenia gravis, multiple sclerosis, Parkinson’s disease, amyotrophic lateral sclerosis)
- Psychological conditions (eg, hysterical aphonia)
Risk Factors
These factors increase your chance of developing aphonia:
- Overusing voice (eg, speaking until you are hoarse)
- Engaging in behaviors that abuse your vocal chords, such as smoking, which also puts you at a higher risk for cancer of the larynx
- Having surgery on or around the larynx
Symptoms
Symptoms may include:
- Inability to speak or inability to speak above a whisper
- Hoarseness
- Spasm of vocal cords
- Throat pain
- Difficulty swallowing (Food or fluids may go into the lungs.)
When Should I Call My Doctor?
Call your doctor if you:
- Have hoarseness that is not getting better after about two weeks
- Have complete loss of voice lasting more than a few days
- Have hard, swollen lymph nodes
- Have difficulty swallowing
- Cough up blood
- Feel of a lump in your throat
- Have severe throat pain
- Have unexplained weight loss
- Have any other concerns
When Should I Call for Medical Help Right Away?
Call for medical help right away or go to the emergency room if you:
- Suddenly lose your ability to speak—This may be a sign of a head injury or a stroke.
- Are having trouble breathing
If you think you have an emergency, call for medical help right away.
Diagnosis
Your doctor will ask about your symptoms and medical history. She will also do a physical exam.
If the underlying cause of your hoarseness is not obvious, you may be referred to a ear, nose, and throat doctor. This doctor may use an instrument called a laryngoscope to examine your vocal cords. They may do other tests to also evaluate your voice function.
If your doctor is concerned that there may be an underlying neurological or psychological concern, you may be referred to other specialists.
Treatment
General measures that can help for laryngitis include:
- Resting your voice
- Avoiding smoking
- Staying hydrated
- Using a cool mist humidifier
- Taking nonprescription pain relievers (eg, acetaminophen, ibuprofen) as needed
Other treatments depend on the specific cause, such as:
- Participating in voice therapy if your loss of voice is due to voice overuse
- Taking medicine to control acid reflux
- Having surgery to remove growths
Prevention
To help reduce your chance of getting aphonia, take the following steps:
- If you smoke, quit.
- If you drink, do so in moderation.
- Limit your exposure to fumes and toxins.
- Avoid talking excessively or yelling.
- Avoid whispering
- If you have to speak a lot for your job, learn proper vocal techniques from a voice therapist.
- Get treatment for underlying conditions that may cause loss of voice.
American Speech-Language-Hearing Association
National Institute on Deafness and Other Communication Disorders
Canadian Association of Speech Language Pathologists
Ontario Association of Speech-Language Pathologists and Audiologists
Acute laryngitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 24, 2011. Accessed Febraury 28, 2012.
Acute laryngitis. Johns Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/health_information_library/index.html?ArticleID=19423#whatis. Accessed December 9, 2008.
Aphonia. American Medical Association Complete Medical Encyclopedia. New York, NY: Random House Reference; 2003;187-187.
Borowski M, Carson-DeWitt R. Conversion disorders. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about. Updated January 2008. Accessed October 28, 2008.
Casthely PA, Labagnara J. Hoarseness and vocal cord paralysis following coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 1992;6:263-264.
Fact sheet: common problems that can affect your voice. American Academy of Otolaryngology website. Available at: http://www.entnet.org/HealthInformation/commonvoiceproblems.cfm. Accessed February 23, 2012.
Hoarseness or loss of voice. The Harvard Medical School Family Health Guide website. Available at: http://www.health.harvard.edu/fhg/symptoms/hoarseness/hoarseness1.shtml?Back=Back. Accessed February 7, 2012.
LaRusso L. Laryngitis. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated September 1, 2011. Accessed February 23, 2012.
Laryngitis. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/laryngitis/DS00366. Updated April 30, 2010. Accessed February 23, 2012.
Maniecka-Aleksandrowicz B, Domeracka-Kolodziej A, Rozak-Komorowska A, Szeptycka-Adamus A. Management and therapy in functional aphonia. Otolaryngol Pol. 2006;60:191-197.
Morales S. Aphonia. Children’s Speech Care Center website. Available at: http://www.childspeech.net/u_iv_b.html. Updated April 2005. Updated April 2005. Accessed November 5, 2008.
Sancho JJ. Pascual-Damieta M, Pereira JA, Carrera MJ, Fontané J, Sitges-Serra A. Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg. 2008;95:961-967.
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. 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.
Wolfe H. Hysterical aphonia & electroacupuncture. Townsend Letter for Doctors & Patients. 2003;(237):139.
Youngson R. Aphonia. Royal Society of Medicine Health Encyclopedia. London, England: Bloomsbury; 2000: 82-82.
Last reviewed February 2012 by Marjorie Bunch, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
