Health Library

Aphonia

What Causes Aphonia?

Aphonia can have different causes:

Aphonia from Physical Causes

Some children’s aphonia can be linked to a physical cause, such as an abnormality in their speech production system. These can include problems with the vocal cords, larynx (voice box) or respiratory system. Examples include:

• Benign callus-like lesions known as vocal cord nodules or cysts – In severe cases, these lesions can prevent vocal cords from vibrating.
• Laryngitis (inflammation of the larynx) – When laryngitis causes significant inflammation and swelling of the vocal cords, it can lead to a temporary or permanent inability to produce a voice.
• Vocal cord paralysis – A lack of proper vocal cord movement on one or both sides can cause aphonia.
• Surgical interventions – Kids who have had surgery to improve breathing function, including airway reconstruction surgery or laryngotracheal reconstruction surgery, can sometimes develop aphonia or dysphonia after these procedures.

Functional Aphonia

Other children’s aphonia comes from the misuse of or inability to correctly use a functioning voice box. Examples include:

• Muscle tension aphonia or dysphonia – This occurs when children use too much tension in their larynx muscles, preventing proper vocal cord function.
• Psychogenic aphonia – Psychological stress, anxiety, depression or emotional trauma can cause a loss of voice.
• Puberphonia – Boys’ attempts to maintain their pre-pubescent, higher pitch during puberty can sometimes lead to vocal loss.

What are the Symptoms of Aphonia?

Aphonia occurs when someone is not able to produce a vocal sound. The symptoms of aphonia are a lack of voice, or a voice that is only a whisper.

While the terms aphonia and aphasia are sometimes confused, they mean different things. Aphonia is the lack of voice. Aphasia is a communication disorder where the person can’t produce understandable speech through normal grammar and sentence structure. In children, aphasia can result after a traumatic brain injury.

How is Aphonia Diagnosed?

Diagnosing aphonia involves a team approach including ear, nose and throat (ENT) specialists, speech pathologists and nurses.

During the evaluation, providers collect information about the child’s voice problem and symptoms, including how long the loss of voice has been observed. The team looks for possible causes in the child’s medical history and daily voice habits.

Vocal Assessment

To be diagnosed with either aphonia or dysphonia, depending on the voice loss severity, your child will have a vocal assessment. During the assessment, providers listen carefully to your child’s voice to evaluate several voice quality characteristics, including roughness, breathiness, strain, pitch and loudness.

Laryngoscopy

In addition to these assessments, ENT specialists examine the patient’s vocal structures. Known as a laryngoscopy, this procedure allows doctors to get an up-close view of your child’s vocal cords and vocal structures while they are talking.

During the procedure, doctors put a small camera scope with a strobe light through the patient’s mouth or nose. The strobe light helps create a series of images that mimic slow motion. This allows them to better see the fast-acting vibration of vocal cords to tell if they are working properly.

For children with aphonia, a laryngoscopy helps determine if structural problems with the child’s voice box are causing their difficulties in voice production.

How is Aphonia Treated?

Treatment for aphonia depends on its cause. For patients suffering voice loss due to a physical or functional cause, medical interventions, such as voice therapy or manual massage of the larynx by a clinician to reduce muscle tightness, can help restore proper vocal function.

In more severe cases of aphonia due to physical causes, such as patients who have had previous airway reconstruction, surgery may be recommended to improve the voice. Surgical options can include:

• Removal of vocal cord cysts
• Vocal cord injections
• Posterior cricoid reduction, a procedure to make the trachea (windpipe) smaller so that vocal cords can come together properly

For patients with vocal misuse, aphonia treatment can include therapy with speech and language pathologists or breathing specialists. These therapies can help kids learn proper vocalization techniques.

Specialized voice therapy can also help children learn to reduce excess muscle tension around their larynx and start new, more normal voicing patterns. For patients with a history of airway reconstruction that resulted in aphonia, therapy can include helping the patient learn to use other structures in the larynx to vibrate and produce sound if the vocal cords do not move properly, such as the false vocal cords.

If aphonia stems from a psychogenic cause like anxiety, stress or depression, then stress management and mental health counseling along with speech therapy can be key in restoring proper vocal function.

How Can Aphonia Be Prevented?

Aphonia due to vocal misuse can be prevented by practicing good “vocal hygiene.” This includes:

• Avoiding vocal overuse, like yelling, screaming or loud talking
• Using a moderate, conversational vocal tone
• Taking vocal breaks
• Drinking plenty of water for proper hydration
• Limiting throat clearing and excessive coughing
• Managing stress and addressing other psychological factors, including anxiety or depression, that might affect vocal health

Aphonia Prognosis

With proper treatment through voice therapy and/or surgical intervention when appropriate, most children with aphonia can regain their voice to some degree.

Vocal recovery success can vary from patient to patient, depending on the root cause of the aphonia. Children who have vocal loss due to muscle tension dysphonia or vocal cord lesions typically see their aphonia improve or resolve entirely with therapy.

For children with vocal cord cysts whose aphonia does not improve with voice therapy, surgical interventions could offer a next-step strategy for voice improvement.

Even patients with more complex medical histories, like airway reconstruction, can expect to achieve improved voice with a combination of appropriate surgical interventions and voice therapy.

For children who have had previous airway reconstruction surgery, finding the right balance between supporting functional breathing and voice production is key.