The 5 types of aphonia (causes, symptoms and treatment)

The human speech apparatus is the set of organs, tissues and structures capable of generating and amplifying sounds so that we have a voice that allows us to communicate. In this sense, the development of this human vocal system is undoubtedly one of the most important biological feats of our species.

Human evolutionary history cannot be understood without the development of this speech apparatus, since it is this that allows us to produce sounds complex enough to make verbal communication possible, the differential feature par excellence with respect to other animals and, in fact, the pillar of our existence.

In this context, it should come as no surprise that voice generation is an incredibly complex process as far as physiology is concerned. And it is that it involves breathing organs (pharynx, larynx, trachea, lungs and diaphragm), phonation organs (larynx, vocal cords, pharynx, nasal cavity and oral cavity) and articulation organs (glottis, palate, tongue, teeth and lips).

Breathing, phonation and articulation are a fundamental part of the emission of sounds that we understand as voice. And problems in any of the many parts that make up these three elements of the speech apparatus can lead to problems of total or partial loss of voice. A situation that, in the clinical field, is known as aphonia.

What is aphonia?

Hoarseness is defined as a partial or total loss of voice. In a more colloquial setting, it is the situation in which we become hoarse. Be that as it may, in a partial aphonia, the patient will present hoarseness; whereas a total aphonia, it will simply be able, at most, to generate whispers. Depending on the cause, this loss of the ability to generate sounds can occur suddenly or more gradually.

It is a clinical condition associated with dysfunctions in the vocal cords (two bands of flexible muscle tissue that are found in the final portion of the larynx and that, when vibrating, allow the production of sounds) or alterations in its structure, as well as disorders psychological or neurological problems that result in muscle coordination failures.

In this context, there are many causes behind aphonia: overexertion of the voice, excessive cold or sudden changes in temperature, excessive use of air conditioning, suffering from gastroesophageal reflux, the consumption of irritating substances (alcohol, tobacco and spicy foods), suffering from respiratory disorders, allergic reactions, the appearance of nodules in the vocal cords… There are many different triggers.

Many different causes that, however, are generally always due to minor and transient injuries in some part of the speech system. Hence, in the vast majority of cases, aphonia can be overcome in a few days by resting the voice, hydrating, avoiding coughing, not breathing through the mouth (it is better through the nose), avoiding noisy environments (because these force us to lift voice), using cold steam humidifiers, taking lozenges, gargling with water and salt ...

In any case, it is also true that this voice disorder that consists of a maximum alteration of the dysphonia (damage in intensity, tone, timbre or duration of the voice) may respond to other triggers that are not limited to minor vocal cord damage, something that results in a different symptomatology from the typical one of "being hoarse". And it is precisely for this reason that we must differentiate between the main classes of aphonia.

What kinds of aphonia are there?

As we have seen, aphonia is defined clinically as a partial or total loss of voice. However, despite the fact that the triggers are very varied, it is possible to classify this disorder based on its general causes. A classification that is essential for the therapeutic approach of the aphonic condition. Let's see, then, what are the main types of aphonia.

1. Organic aphonia

Organic aphonia is one in which the loss of voice arises due to anatomical lesions in the organs of the speaking apparatus. That is, it is the type of aphonia in which the problem appears due to internal damage to the tissues of the structures that intervene in the process of respiration, phonation or articulation, with the larynx and vocal cords being the most commonly used structures. are affected.

The larynx is a tubular organ of a muscular nature that, being made up of nine cartilages, has the function of, in terms of phonation, to house the place where sound is physically produced. And it is that in its terminal portion are the vocal cords, two bands of flexible muscle tissue that, at rest are relaxed, but when we want to generate sounds, they contract when the expired air passes through them, generating a vibration that culminates in the production of sounds and voice.

In this context, irritations, allergic reactions, infections, thyroid gland disorders, nodules or polyps, cancer of the larynx, paralysis of the vocal cords due to neurological dysfunctions, alterations in muscular coordination, congenital malformations of the speech apparatus, arthritis problems, respiratory diseases ... These and other pathologies can cause this form of organic aphonia.

2. Psychogenic aphonia

Psychogenic aphonia is one in which the loss of voice arises as a psychomatization of a psychological problem. That is, it is the type of aphonia in which the problem does not arise from damage to the speaking organs (at an organic level, everything is fine), but as a physical manifestation of a disorder of emotional or psychological origin.

It is no secret that psychological discomfort somatizes with problems on a physical level. And the loss of voice is one of the most common psychosomatizations. Psychological disorders mean that, despite the fact that there is no organic damage, the vocal cords cannot join and / or separate normally, something that causes this loss of voice. Sudden changes in life, moments of very strong emotional stress, obsessive disorders, situations of terror ... There are many situations in which emotional discomfort can cause a more or less serious loss of voice.

In case it is a momentary situation that has been triggered by a specific negative experience, we should not worry. We have all lost our voices at some point due to nerves or any other psychological trigger. But if we cannot find the origin of this discomfort and / or the incidence is too frequent, then we should put ourselves in the hands of a mental health professional.

3. Traumatic aphonia

Traumatic aphonia is one in which the loss of voice arises as a consequence of external trauma that damages the speech apparatus. That is, aphonia does not appear due to internal damage (except in those cases due to intracranial intubations or implantation of nasogastric tubes), but to external damage that causes a partial or total loss of voice.

We are talking about traffic accidents that damage the organs of the speech apparatus, puncture wounds in the larynx area, injuries to the neck, burns ... In this case, the treatment will require surgical intervention, although in some cases they cannot completely repair the ability to speak and is sometimes even contraindicated.

4. Hearing aphonia

Hearing aid or audiogenic aphonia is one in which the loss of voice arises as a result of hearing impairment. That is, aphonia appears not due to the somatization of psychological disorders or internal (such as organic) or external (such as traumatic) injuries, but rather due to a hearing deficit.

In this case, more than aphonia as such, it is related to a generation of unintelligible sounds, since the person, by not listening well, cannot speak normally. It usually appears, therefore, by hearing loss (difficulty perceiving sounds) or by cophosis (inability to perceive sounds). Treatment will be focused on treating these sensory disabilities of the sense of hearing.

We are, then, before a type of aphonia that arises as a consequence of a more or less severe deafness, which is especially noticeable when the auditory threshold (the minimum intensity of sound capable of being detected by a person's ear) is below above 90 dB.

5. Functional aphonia

Functional aphonia is one in which the loss of voice is caused by an alteration in some region of the speech apparatus but without being able to speak of an injury as such. It is the most common form and we leave it for last since there is no internal or external damage, it is not due to a somatization of a psychological problem, nor is it linked to deafness.

So why does it appear? This functional aphonia is a loss of voice that generally appears due to overexertion of the voice, misuse of the speech apparatus, poor or exaggerated laryngeal muscle tones, etc. Non-traumatic situations that, yes, can make us hoarse. Treatment is enough to correct these bad habits, something that can be easily achieved with the help of a speech therapist.