aphonia

Aphonia is the complete loss of voice, or the inability to produce audible vocal sounds despite attempted phonation. Some individuals can only whisper. It differs from dysphonia, which refers to impaired voice quality rather than total loss of voice.

Aphonia arises from disruption of the laryngeal mechanism or its neural supply. Organic causes include laryngitis, vocal fold paralysis or paresis from vagus nerve injury, lesions such as nodules or polyps, trauma, tumors, and infections. Neurological disorders like stroke or amyotrophic lateral sclerosis can also cause it. Psychogenic or functional aphonia has no identifiable structural cause and is associated with stress or conversion phenomena.

In organic aphonia, the vocal folds fail to vibrate or approximate, eliminating phonation. In functional aphonia, the larynx is structurally normal, but voice production is inhibited. The latter is considered a form of functional neurological symptom.

Diagnosis involves history and examination by an ear, nose, and throat specialist, with laryngoscopy or videostroboscopy to assess vocal fold movement. Additional assessment by a speech-language pathologist, and neurological evaluation, may be used. The differential includes laryngitis, paralysis, tumors, and neurologic disorders.

Treatment targets the underlying cause. Infections or inflammation may improve with rest and medical therapy; nerve or structural problems may require surgical or prosthetic approaches. Functional aphonia often responds to voice therapy and, when needed, psychological support. Prognosis varies with the underlying condition.