Aphonia
ICD 784.41

Article by:
Sarah Morales, BS
Children's Speech Care Center

Aphonia means "no voice." In other words, a person with this disorder has "lost" his/her voice. There are many reasons why this may happen. Basically, any injury or condition that prevents the vocal cords (called vocal folds in speech-language pathology), the paired bands of muscle tissue positioned over the trachea (windpipe), from coming together and vibrating will have the potential to make a person unable to speak. When a person prepares to speak, the vocal folds come together over the trachea and vibrate due to the airflow from the lungs. This mechanism produces the sound of the voice. If the vocal folds cannot meet together to vibrate, sound will not be produced. Aphonia may vary over time (i.e. become worse at night, become better after sleep, occur sporadically for no apparent reason, etc.).

In a common cold or flu (also called URI-upper respiratory infection) or an allergy, the vocal folds may not meet together to vibrate properly due to excessive mucous or general swelling of throat tissues. Benign (non-cancerous) or malignant (cancerous) growths on the vocal folds would prevent vibrations of the vocal folds by altering the straight shape of their edges. Neurogenic voice disorders (disorders due to nerve or brain damage) include paralysis of the vocal folds, a condition that would prevent the meeting of the folds for vibration (i.e. one or both folds won't move). Spasmodic dysphonia (spasms of the vocal folds) can cause the vocal folds to freeze in an open position, preventing their coming together for vibration. Neurological disorders such as myasthenia gravis, multiple sclerosis, Parkinson's disease, and amyotrophic lateral sclerosis involve the gradual destruction of nerve tissue, which may cause vocal fold paralysis. Vocal fold paralysis may also occur as the result of a disturbance in the function of nerves that reach the larynx ("voice box"-contains the vocal folds and other muscles, tissues) due to heart surgery; these nerves run a course located near the heart.

Some voice disorders are idiopathic (meaning unknown in origin-i.e. absence of growths, paralysis, etc.), and may occur due to stress. For example, a friend of mine once "lost her voice" during her divorce and was treated by a speech-language pathologist. Vocal abuse (e.g., excessive yelling/talking, smoking, drinking excessive caffeine or alcohol, excessive exposure to fumes/toxins, etc.) is another potential cause of aphonia. These actions of an individual may cause inflammation of the vocal folds or the occurrence of growths on the vocal folds (i.e. cancerous growth from smoking; small bumps called nodules from excessive, strenuous use of the voice).

If aphonia persists beyond the duration of a common cold/flu, or begins in the absence of a URI, it should be examined by a qualified professional. Colds and allergies (if they are the source of aphonia) can be treated easily by a physician or with over-the-counter medications. Usually, a team approach is needed to treat this type of disorder (i.e., speech-language pathologist, ear-nose-throat doctor or otolaryngologist, and a physician). Surgery and therapy or either one of these may be recommended. Therapy is usually brief.

Some informative links include:
www.voice-center.com
www.asha.org
www.slpsite.com