Home Symptoms Aphonia (loss of voice) : duration, treatment and causes

Aphonia (loss of voice) : duration, treatment and causes

by Josephine Andrews
Published: Last Updated on 241 views

Aphonia is the strongest form of hoarseness (dysphonia). The voice loses its tone, those affected can only whisper or breathe. The lack of voice is usually triggered by physical causes, sometimes it is also psychological. In most cases, aphonia is curable. Read here how long it takes for the voice to return and how aphonia is treated.

quick overview

  • Duration: How long voice loss lasts depends on the cause. Usually the voice comes back.
  • Treatment: Aphonia can usually be treated well with voice rest, medication, logotherapy, psychotherapy , and surgery is rarely necessary.
  • Causes: Aphonia can have various physical and mental causes.
  • When to see a doctor: If the aphonia comes on suddenly or lasts longer than three weeks.
  • Diagnostics: clinical picture, examination of the larynx, further examinations: ultrasound , CT, MRT.
  • Prevention: Do not overstrain your voice, healthy lifestyle (abstaining from alcohol and nicotine).

How long does the voice loss last?

How long the voice loss lasts depends on its cause. A harmless cold is usually behind the lack of voice. In these cases, the best thing to do is rest your voice. It usually takes a few days for her to come back.

Anyone who is professionally dependent on their voice (e.g. teacher or singer) and puts too much strain on it may have to struggle with recurring aphonia. Again, it is important to protect the voice. In addition, voice training with a speech therapist helps to strengthen the voice and prevent relapses.

Tumors or nerve-related vocal cord damage can take longer to heal, in some cases even years. Complete paralysis of the vocal cords (such as after a stroke or after surgery) can sometimes remain permanent.

The prognosis is generally good: the loss of voice is usually curable. In any case, it is advisable to see a doctor soon after the voice loss occurs. This is especially true if the aphonia has psychological causes. The longer the voice loss goes untreated, the more lengthy the treatment.

If the voicelessness lasts longer than three weeks, it is advisable to consult an ENT doctor or phoniatrist!

What can you do when the voice is gone?

If the voice loses its tone, this is an alarm signal. It is advisable to act at the first symptoms to avoid worsening. If the cause of the lack of voice is unclear or if the voice stays away for more than three weeks, it is advisable to see a doctor. If the aphonia is accompanied by a respiratory infection, the following tips may help:

  • Save your voice.
  • Avoid clearing your throat and whispering, instead give a short cough and speak softly.
  • Avoid stress.
  • Try relaxation exercises.
  • Refrain from alcohol and smoking.
  • Drink enough.
  • Avoid dry heating air, because it dries out the mucous membranes.

Home remedies for voice loss

In addition, the following home remedies can help with voicelessness:

Gargling with salt water: Gargling with salt water is said to have an anti-inflammatory and decongestant effect. To do this, mix a teaspoon of salt with 250 ml of lukewarm water. The salt dissolves faster in it than in cold water. Gargle for about five minutes every two to three hours.

Gargling with sage : You can also use sage instead of salt. Sage is said to have antibacterial and anti-inflammatory effects. Either prepare a commercial sage tea or add a handful of fresh sage leaves to the simmering water. Allow the brew to steep for about five minutes before gargling.

Inhaling with salt water: As an alternative to gargling, you can also inhale if you lose your voice. To do this, bring about a liter of water to a boil and add a tablespoon of salt. Allow the liquid to cool slightly (caution: risk of scalding!) Bend over the pot and hold a towel over your head. Breathe in and out deeply, keep your eyes closed. The water vapor penetrates deep into the respiratory tract and unfolds its effect there.

Teas: Preparations with ginger , thyme , buckhorn or mallow leaves soothe the mucous membranes and alleviate the symptoms.

Neck wraps: Neck wraps are a proven home remedy for colds. They can be used hot or cold, dry or wet. The principle is always the same: A cotton cloth is placed over the neck and covered and fixed with another cloth.

Read here how to use the neck wrap correctly .

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

What helps against cough and no voice?

If aphonia and cough are present at the same time, there is usually an acute inflammation of the larynx (laryngitis) behind it. Normally, it is harmless and heals on its own within a few days – provided the patient really takes care of their voice. If there are other symptoms such as fever or shortness of breath, it is advisable to see a doctor. In addition to resting your voice, he will prescribe antipyretic and cough-relieving medication.

Treatment at the doctor

Therapy of organic aphonia

If the doctor finds a physical cause for the loss of voice, he initiates appropriate treatment.

If you have a cold or laryngitis, it is usually sufficient to rest your voice. If the patient has other symptoms such as a sore throat or cough, the doctor usually treats them symptomatically, for example with lozenges or cough suppressants. If there is a fever, the doctor will prescribe antipyretics. Antibiotics are only used if the doctor detects a bacterial infection. When the cold heals, the voice comes back.

If there are changes in the vocal folds such as cysts or polyps, an operation may be necessary. The same applies to papillomas (benign growths) and other tumors. After the operation, the voice still needs some rest. This is usually followed by voice therapy with a speech therapist. He helps with special exercises to rebuild the normal voice function.

Therapy functional aphonia

Voice overload: If you lose your voice again and again for work-related reasons, voice training with a speech therapist is helpful. It can help to train the voice and teach the correct breathing technique. Those affected learn techniques that they can apply independently at home. They strengthen the vocal cords and prevent relapses.

Psychogenic aphonia: In the case of psychogenic (or dissociative) aphonia, it is first important to find out which psychological causes led to the loss of voice. For this, the doctor refers the patient to a psychotherapist. Ideally, this person is also trained in speech therapy. In dissociative aphonia, the combination of psychotherapy and logotherapy is most effective.

It is important to start treatment early. Treating psychogenic aphonia can take time.

Aphonia with psychological causes can also be cured. Don’t lose heart, in most cases the voice will come back!

Causes and possible diseases

The lack of voice can have different causes. In most cases, it is harmless colds that cause voice loss. If the vocal cords no longer produce an audible sound, in some cases there are also serious diseases behind it.

Aphonia: Physical (organic) causes

Cold: Colds often lead to irritation of the larynx. They are mostly caused by viruses . Inflammation and swelling in the area of ​​the vocal cords can cause hoarseness up to aphonia. If the voice already sounds rough and hoarse and is still not spared, aphonia develops: the voice disappears completely. Harmless colds usually heal on their own after a few days.

Laryngeal irritation: Nicotine, alcohol, caffeine or environmental toxins such as asbestos irritate the mucous membranes and damage the vocal folds.

Acute laryngitis: An inflammation of the larynx (acute laryngitis) usually begins with hoarseness and pain when swallowing, sometimes with fever. Most often, viruses cause laryngitis. If the voice is not spared, aphonia can develop. The inflamed and swollen vocal folds no longer produce sound. The severe swelling in the area of ​​the larynx can lead to shortness of breath. In children, this is referred to as pseudocroup .

Chronic laryngitis: In the case of chronic laryngitis, the symptoms occur with varying degrees of intensity over a period of several weeks. The symptoms range from hoarseness to complete aphonia. In addition, there is urgency to clear your throat, coughing and pain in your throat.

Diphtheria : Main features of diphtheria (true croup) are barking cough, hoarseness and voicelessness. When inhaling, whistling sounds are audible. Diphtheria is rare these days because there is a vaccine against it. If diphtheria breaks out anyway, it is easily treatable.

Larynx papillomatosis: Larynx papillomatosis is a disease caused by human papilloma viruses (HPV). This leads to wart-like growths (papilloma) in the area of ​​the larynx. If these papillomas are on the vocal folds, aphonia can result. Increasing symptoms such as hoarseness, breathing difficulties and a hissing-whistling sound caused by the narrowed airways ( stridor ) are typical of laryngeal papillomatosis.

Polyps on the vocal folds: Polyps are growths on the mucous membrane. They become noticeable through hoarseness, a foreign body sensation and a compulsion to clear your throat. Smokers are particularly affected.

Injury to the larynx from intubation : Intubation is necessary when a patient cannot breathe on their own. This can be the case for operations under general anesthetic or as part of rescue operations. To do this, the doctor inserts a breathing tube into the patient’s nose or mouth. He is artificially ventilated via the tube. In some cases, the vocal cords on the larynx may be injured when inserting the tube.

Paralyzed vocal cords: Vocal cord paralysis can also cause aphonia. It is triggered, for example, by a stroke or surgery in the course of the recurrent nerve (the nerve that controls the vocal folds). This can be the case, for example, with interventions on the thyroid gland or inside the chest. With bilateral paralysis , the glottis remains narrow and the vocal folds cannot move apart.

Tumors on the vocal cords or larynx: Tumors on the vocal cords or larynx can lead to total voice loss. Alarm signal is a long-lasting hoarseness or loss of voice. The main risk factors are smoking, alcohol and environmental toxins such as asbestos.

Neurological diseases: Diseases such as Parkinson’s or multiple sclerosis, which are associated with damage to the nerves, can also affect the vocal folds and lead to aphonia.

Non-organic (functional) causes

If the voicelessness has no physical causes, it is referred to as non-organic or functional aphonia.

It can be caused by overuse of the voice or have psychological causes. Those affected are otherwise physically healthy. Before a doctor diagnoses functional aphonia, he first rules out physical causes.

overuse of the voice

People who speak or sing a lot for work reasons often experience voice overstrain. The risk group includes, for example, teachers, speakers or singers. As a result of the permanent strain on the vocal folds, so-called singer nodules form. They consist of connective tissue and impede the vibrations of the vocal folds. The voice disorder initially causes hoarseness. If the voice is not consistently spared, it eventually fails completely.

Psychogenic aphonia

In the case of psychogenic (or dissociative) aphonia, the cause of the loss of voice lies in the psyche. Those affected are otherwise physically healthy. It is typical of psychogenic aphonia that the loss of voice occurs suddenly. Affected people fall silent literally “overnight”. Most of the time it’s women who can’t get a sound out.

With psychogenic aphonia, the voice is toneless, only a whisper and a breath are possible. However, the vocal function is still present: although the voice stops when speaking, it remains voiced when clearing the throat, sneezing, coughing and laughing. This peculiarity distinguishes psychogenic from organic aphonia.

Affected people often report that they have been silent for a long time about very stressful feelings such as sadness or anger instead of expressing them. The loss of voice is an expression of escaping the unbearable situation through silence.

Possible causes are:

  • Highly stressful events (trauma, shock )
  • fear
  • prolonged stress
  • conflict situations
  • Difficult life situations
  • Strong nervousness, insecurity
  • depressions
  • neuroses
  • disgust

In the case of psychogenic aphonia, there are no indications of physical causes such as infections or previous diseases of the vocal tract. The voice stops because the vocal cords can no longer be closed when speaking. They are either too little or too tight. There is also tension in the larynx, neck and shoulders. If the doctor examines the vocal cords with a laryngoscope, he often finds that they are red. However, these changes are not the cause of dissociative aphonia, but rather their consequence.

When to the doctor?

It is usually colds that lead to hoarseness or aphonia. If symptoms such as a sore throat or runny nose are present at the same time, a flu-like infection is likely. The symptoms usually heal within a few days.

If the cause of the lack of voice is obvious , such as after attending a concert or in the case of work-related overstrain, a doctor’s visit is usually not necessary. Here it is sufficient to rest the voice for a few days.

If the voice loss occurs without an accompanying infection or all of a sudden, a doctor should find out the cause. The same applies if the voice is absent for more than three weeks.

Be sure to see a doctor if

  • The cause of aphonia is unclear
  • The loss of voice occurs again and again
  • At the same time, there are symptoms such as a foreign body sensation, fever or breathing difficulties
  • The voice did not come back after three weeks despite rest
  • Psychological causes could be behind the loss of voice

What is aphonia?

Aphonia is the maximum form of hoarseness ( dysphonia ). The term derives from the Greek (άφωνια, α “not” and φωνή, phone, “voice”) and means voiceless. In contrast to hoarseness, where the voice can still be heard, aphonia describes the complete loss of voice. Those affected can only whisper or breathe.

Aphonia is not a language disorder: Those affected have normal language skills, but cannot speak because their voice is failing.

In addition to the loss of voice, other physical symptoms are possible. Patients report pain when trying to speak and unusually frequent throat clearing. Tension in the neck and neck area is very common. They sometimes lead to headaches . In severe cases, there is also a foreign body sensation (lump in the throat).

How is the voice created?

The human voice is produced in the larynx. When the exhaled air flows past the vocal folds (also called vocal cords), they vibrate. When speaking, the vocal cords are tense. This narrows the so-called glottis, the gap between the vocal cords. Depending on how far the glottis closes, the tone changes. The sound is formed and amplified in the nose, mouth and throat area and finally formed into a sound with the tongue and lips.

In aphonia, the glottis remains open because the vocal folds spasm or cannot close properly. No audible sound is produced, only whispering is possible.

What does the doctor?

Aphonia that occurs suddenly or lasts longer than three weeks should be clarified by a specialist. Otherwise the voice can be permanently damaged. The right contacts for aphonia are the ENT doctor or a phoniatrist. The phoniatrician specializes in diseases of the voice, language, hearing and swallowing.

The doctor tries to find out what caused the loss of voice. To do this, he first inquires about the symptoms and how long they have existed.

He may ask the following questions:

  • How long has it been since you lost your voice?
  • Was the voice heavily used before the onset of aphonia?
  • Are you a teacher/educator/speaker/singer/actor?
  • Are you aware of diseases of the respiratory tract or the larynx?
  • Did you have an operation, for example on the chest or throat, shortly before the voice loss occurred?
  • If so, was the operation performed under general anesthesia with artificial respiration?
  • Do you smoke? If so, how much and for how long?
  • Do you drink alcohol? When Yes, how much?
  • Do you have a foreign body sensation in the throat area?
  • What medications are you currently taking?

Then he examines the pharynx, larynx and vocal folds for changes. To do this, he uses a laryngoscope, a special device that allows him to look at the larynx.

If there is a suspicion of a viral or bacterial infection, the doctor takes a swab from the throat. This is then examined in the laboratory for possible pathogens.

A blood test provides information on whether there are signs of an inflammatory reaction in the body.

If a tumor in the larynx is suspected, imaging methods are used, for example an ultrasound examination (US), computed tomography (CT) or magnetic resonance imaging (MRI).

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