Dysphonia is understood as a qualitative change in the voice, which can be of both organic origin and be of a functional nature. In most cases, the symptoms are due to an inflammatory, infectious or neoplastic process. In this case, we are talking about the organic nature of the defeat. It must be distinguished from those conditions based only on functional disorders. In order to prescribe the correct treatment to a patient, it is necessary to find out what functional dysphonia is, how it differs from organic dysphonia, and what symptoms are characterized.
Signs
The main signs that characterize dysphonia are:
- hoarseness;
- hoarseness;
- fatigue from talking;
- transition to a whisper;
- decreased voice range;
- split tone;
- confusion of speech;
- change of tonality.
With severe functional disorders, inflammatory processes, tumors, a condition characterized by a complete absence of sound, aphonia, can develop. Whispering speech may also be absent.
Factors contributing to dysphonia
Sound is produced by a stream of air that leaves the lungs and travels along the trachea to the larynx. In this case, the vocal cords must be closed. It is during their closing and oscillation that a wave arises, which causes the formation of sounds. If the vocal cords are pulled apart, vibration will not occur and there will be no voice. The development of a pathological process in the organs involved in sound reproduction leads to dysphonia.
The causes of dysphonia can vary. In the development of organic disorders, the main role is played by such diseases:
- laryngitis;
- laryngotracheitis;
- tumor processes;
- SARS and other acute infectious diseases.
The most common causes of functional dysphonia are
- endocrine system diseases;
- overstrain of the muscular apparatus of the vocal cords;
- pathology of the nervous system;
- surgery in the neck;
- stress;
- the use of medicines.
Diagnostics
The main diagnostic feature that makes it possible to distinguish between the organic and functional nature of dysphonia is the results of laryngoscopy.
The use of such endoscopic diagnostics, especially microlaryngoscopy, can reveal hyperemia and edema of the vocal cords or the entire larynx, the presence of tumor-like formations, which confirms the organic nature of the lesion. The absence of inflammatory changes in the presence of disturbances in the work of the ligamentous apparatus testifies in favor of functional disorders.
The functional nature of the disorders is also confirmed by the duration of the symptoms. If a change in voice is noted for many months, and the general condition remains the same, then this is evidence in favor of functional dysphonia. In doubtful cases, to clarify the nature of the lesion, computed tomography of the larynx is shown, which makes it possible to more informatively determine tumor processes.
Classification
By the nature of functional disorders, dysphonia are heterogeneous. The most common forms are:
- hypotonic;
- hypertonic;
- spastic;
- mutational.
The most common is the hypotonic form, which is caused by a decrease in the tone of the muscles that form the vocal folds. As a result of such violations, the glottis cannot completely close, which leads to the development of certain symptoms. Mutational dysphonia is not accompanied by any changes in the ligamentous apparatus. It is due to hormonal changes occurring in adolescents. Hypertensive dysphonia is characterized by increased tone of the muscles involved in voice formation. In this case, attention is drawn to the participation of the neck muscles in the phonation process, which facilitates the diagnosis.
Spastic dysphonia is considered a manifestation of a nervous disorder, although the reasons for its development have not been reliably clarified. As a result of the lesion, uncoordinated movements of the vocal cords occur, which are manifested by severe symptoms. There are two types of violation. Spasmodic dysphonia of the adductive type is characterized by excessive closure of the vocal cords during the pronunciation of a sound. Dysphonia is characterized as an unnatural, confused, tense voice. Pronounced articulation is present.
At the same time, spastic dysphonia of the abductive type is characterized by an opening of the vocal cords. Clinically, such a voice is silent. The process is characterized by a regular change of one type or another within a short time, even within a day. Such a course of the process negatively affects the patient's interpersonal contacts, there is discomfort when communicating with strangers, public speaking is difficult.
Severe symptoms and a severe course of pathology force patients to consult with psychiatrists. This is also due to the fact that spastic dysphonia is characterized by difficult diagnosis. Objectively, pathological processes can be detected only when the vocal cords move. Consequently, indirect laryngoscopy, available in any medical institution, will be of little information. Diagnostics is recommended to be carried out during sound reproduction, which is more convenient to perform during endoscopic examination.
Treatment principles
The causes of dysphonia can vary and are not always obvious. In this regard, in addition to examining the patient by an otolaryngologist, consultations of related specialists, an endocrinologist, a neurologist, a psychiatrist, a phoniatrist, a speech therapist, etc. are necessary. Treatment of functional dysphonia should be comprehensive. Treatments include
- the use of medicines;
- non-drug activities;
- surgery;
- the use of traditional medicine.
The choice of treatment method depends on the identified objective changes, clinical manifestations, the severity of the condition, the patient's age, the need to perform professional tasks.
There are certain requirements for the prevention and treatment of any type of vocal cord injury and dysphonia due to functional impairment:
- eliminate bad habits, smoking and alcohol abuse;
- carry out constant moisturizing of the throat, which prevents the development of inflammatory processes;
- avoid overstrain of the vocal cords, do not shout, talk in a whisper for a long time;
- exclude spicy, spicy, too hot or cold foods from the diet;
- to reorganize the pathology of the throat, as well as diseases accompanied by gastroesophageal reflux.
The use of drug treatment depends on the form of functional dysphonia.
With hypotonic dysphonia, the drug Proserin is used in a short course, which enhances the contractility of smooth muscles.
Vitamins of group B are actively used. Mutational dysphonia caused by age-related changes in adolescents does not need additional treatment. The main therapeutic measures in this case are preventive measures and a sparing attitude to the work of the vocal apparatus. Spastic dysphonia is the form of pathology where a well-known agent in cosmetology is used - botulinum toxin, its injectable form, Botox.
Non-pharmacological measures used for functional dysphonia are as follows:
physiotherapy procedures;- acupuncture;
- collar zone massage;
- phonopedic exercises.
physiotherapy procedures;Amplipulse is the most widespread among physiotherapeutic procedures. With muscle hypotonia, electrophoresis with Proserin's solution and electrostimulation with diadynamic currents directed specifically to the larynx region are effective.
Phonopedic exercises help to teach the patient phonation in conditions of insufficient work of the vocal apparatus. This is achieved by numerous repetitions of certain combinations of sounds, correct breathing and posture. With a decrease in the tone of the muscles of the vocal cords, hardware techniques are also used to improve neuromuscular transmission.
With hypotonic dysphonia, surgical treatment is also most often used. Phonosurgery has two directions: the effect on the vocal cords, as well as thyroplasty, in which surgical intervention consists in an operation on the cartilage of the larynx. By carrying out certain interventions on these structures of the larynx, the closure of the vocal cords also improves.
Surgical treatment of the vocal cords carries a high risk, as it can lead to scarring and further stenosis of the larynx.
In this respect, thyroplasty is a safer method of exposure. However, due to the complexity of the surgical intervention, the question of phonosurgery can be raised only as a result of the ineffectiveness of other methods of treatment.
Functional dysphonia is considered a reversible process. However, an inattentive attitude to this problem, refusal of treatment, can lead to an aggravation of the situation, and, as a consequence, the development of organic lesions.
