Brief overview
- Duration: How long the loss of voice lasts depends on the cause. The voice usually returns.
- Treatment: Aphonia can usually be treated well with voice preservation, medication, speech therapy, psychotherapy, surgery is rarely necessary.
- Causes: Aphonia can have various physical and psychological causes.
- When to see a doctor: If the aphonia occurs suddenly or lasts longer than three weeks.
- Diagnosis: clinical picture, examination of the larynx, further examinations: Ultrasound, CT, MRI.
- Prevention: Do not overuse your voice, lead a healthy lifestyle (avoid alcohol and nicotine).
How long does voice loss last?
How long voice loss lasts depends on the cause. In most cases, a harmless cold is behind the loss of voice. In these cases, the best thing to do is to take it easy on your voice. It usually takes a few days before it returns.
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 remain permanent under certain circumstances.
The prognosis is generally good: the loss of voice is usually curable. In any case, it is advisable to consult a doctor soon after the onset of voice loss. This is especially true if the aphonia has psychological causes. The longer the voice loss remains untreated, the more protracted the treatment will be.
If the loss of voice lasts longer than three weeks, it is advisable to consult an ENT specialist or phoniatrist!
What can you do if your voice is gone?
If the voice loses its tone, this is an alarm sign. It is advisable to take action as soon as the first symptoms appear in order to prevent deterioration. If the cause of the loss of voice is unclear or if the voice remains absent for longer than three weeks, a visit to the doctor is advisable. If the aphonia is accompanied by a respiratory infection, the following tips may help:
- Protect your voice.
- Avoid stress.
- Try relaxation exercises.
- Avoid alcohol and smoking.
- Drink enough fluids.
- Avoid dry heating air, as it dries out the mucous membranes.
Home remedies for voice loss
The following home remedies can also help with loss of voice:
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 more quickly in this 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 an antibacterial and anti-inflammatory effect. Either prepare a commercially available sage tea or add a handful of fresh sage leaves to boiling water. Allow the brew to infuse for about five minutes before gargling.
Teas: Preparations with ginger, thyme, ribwort or mallow leaves soothe the mucous membranes and relieve the symptoms.
Throat compresses: Throat compresses are a tried and tested household remedy for colds. They can be applied warm or cold or dry or moist. The principle is always the same: a cotton cloth is placed over the neck and covered and secured with another cloth.
You can find out how to apply neck compresses correctly here.
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 coughing and no voice?
If you have aphonia and a cough at the same time, this is usually due to acute laryngitis. Normally, it is harmless and heals on its own within a few days – provided the patient really does take care of their voice. If other symptoms such as fever or shortness of breath occur, a visit to the doctor is advisable. He or she will prescribe antipyretic and cough-relieving medication in addition to voice protection.
Treatment by a doctor
Treatment of organic aphonia
If you have a cold or laryngitis, it is usually sufficient to take it easy on your voice. If the patient also has other symptoms such as a sore throat or cough, the doctor usually treats them symptomatically, for example with lozenges or cough suppressants. If the patient has a fever, the doctor will prescribe antipyretics. Antibiotics are only used if the doctor diagnoses a bacterial infection. If the cold heals, the voice will also return.
Surgery may be necessary if there are changes to the vocal folds, such as cysts or polyps. The same applies to papillomas (benign growths) and other tumors. After the operation, the voice needs some time to rest. This is usually followed by voice therapy with a speech therapist. This helps to restore normal vocal function with special exercises.
Functional aphonia therapy
Psychogenic aphonia: In the case of psychogenic (or dissociative) aphonia, it is first important to find out what psychological causes have led to the loss of voice. To do this, the doctor refers the patient to a psychotherapist. Ideally, the therapist will also be trained in speech therapy. In the case of dissociative aphonia, a combination of psychotherapy and speech therapy is most effective.
It is important to start therapy at an early stage. The treatment of psychogenic aphonia can take some time.
Aphonia with psychological causes can also be cured. Don’t lose heart, in most cases your voice will come back!
Causes and possible illnesses
Voicelessness can have various causes. In most cases, the loss of voice is caused by harmless colds. However, if the vocal cords no longer produce an audible sound, in some cases there are also serious illnesses behind it.
Aphonia: Physical (organic) causes
Laryngeal irritation: Nicotine, alcohol, caffeine or environmental toxins such as asbestos irritate the mucous membranes and thus damage the vocal folds.
Acute laryngitis: Laryngitis (acute laryngitis) usually begins with hoarseness and pain when swallowing, sometimes accompanied by fever. Laryngitis is usually caused by viruses. If the voice is not spared, it can develop into aphonia. The inflamed and swollen vocal folds no longer produce any 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, symptoms occur to varying degrees for several weeks. The symptoms range from hoarseness to complete aphonia. They are accompanied by difficulty clearing the throat, coughing and pain in the throat.
Diphtheria: The main symptoms of diphtheria (true croup) are a barking cough, hoarseness and loss of voice. Whistling noises are audible when inhaling. Diphtheria rarely occurs nowadays as there is a vaccination against it. However, if diphtheria does break out, it is easily treatable.
Polyps on the vocal folds: Polyps are growths on the mucous membrane. They make themselves felt through hoarseness, a foreign body sensation and a compulsion to clear the throat. Smokers are particularly affected.
Injury to the larynx due to intubation: Intubation is necessary if a patient is unable to breathe on their own. This can be the case during operations under general anesthesia or during rescue operations. The doctor inserts a breathing tube into the patient’s nose or mouth. The patient is artificially ventilated via the tube. In some cases, the vocal cords in the larynx may be damaged when the tube is inserted.
Paralyzed vocal cords: Paralyzed vocal cords can also cause aphonia. It can be triggered by a stroke or surgery in the area where the recurrent laryngeal nerve (the nerve that controls the vocal folds) runs, for example. This can be the case, for example, during surgery on the thyroid gland or inside the chest. In the case of bilateral paralysis, the glottis remains narrow and the vocal folds cannot move apart.
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 overstraining the voice or have psychological causes. Those affected are otherwise physically healthy. Before a doctor diagnoses functional aphonia, they first rule out any physical causes.
Overuse of the voice
People who speak or sing a lot for professional reasons often overuse their voice. This risk group includes teachers, speakers and singers, for example. As a result of the constant strain on the vocal folds, so-called singer’s nodules form. They consist of connective tissue and hinder the vibration of the vocal folds. The voice disorder initially causes hoarseness. If the voice is not consistently protected, it will eventually fail completely.
Psychogenic aphonia
In psychogenic aphonia, the voice is toneless, only whispering and breathing is possible. However, vocal function is still present: Although the voice stops when speaking, it remains vocal when clearing the throat, sneezing, coughing and laughing. This characteristic distinguishes psychogenic aphonia from organic aphonia.
Sufferers often report that they have previously kept silent for a long time about strongly stressful feelings such as sadness or anger instead of expressing them. The loss of voice is an expression of trying to escape the unbearable situation by remaining silent.
Possible causes are
- Highly stressful events (trauma, shock)
- Anxiety
- Prolonged stress
- Conflict situations
- Difficult life situations
- Severe nervousness, insecurity
- Depression
- Neuroses
- Disgust
When to see a doctor?
It is usually colds that lead to hoarseness or aphonia. If symptoms such as a sore throat or a cold 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 loss of voice is obvious, for example after attending a concert or due to work-related overuse, it is not usually necessary to see a doctor. In this case, it is sufficient to rest the voice for a few days.
If the loss of voice occurs without an accompanying infection or suddenly, a doctor should investigate the cause. The same applies if you lose your voice for longer than three weeks.
Be sure to see a doctor if
- The cause of the aphonia is unclear
- The loss of voice occurs repeatedly
- You also have symptoms such as a foreign body sensation, fever or breathing difficulties
- The voice has not returned after three weeks despite rest
- There could be psychological causes behind the voice loss
What is aphonia?
Aphonia is not a speech disorder: those affected have normal speech, but cannot speak because their voice fails.
In addition to the loss of voice, other physical symptoms are possible. For example, patients report pain when trying to speak and unusually frequent clearing of the throat. Tension in the throat and neck area is very common. This sometimes leads to headaches. In severe cases, there is also a foreign body sensation (lump in the throat).
How is the voice formed?
The human voice is produced in the larynx. When the exhaled air flows past the vocal folds (also known as vocal cords), they begin to vibrate. When speaking, the vocal cords are tense. This causes the glottis, the gap between the vocal cords, to narrow. The sound changes depending on how far the glottis closes. The sound is formed and amplified in the nasopharynx, mouth and throat and finally formed into a sound with the tongue and lips.
In aphonia, the glottis remains open because the vocal folds cramp or cannot close properly. No audible sound is produced, only whispering is possible.
What does the doctor do?
The doctor tries to find out what has led to the loss of voice. To do this, he will first ask about the symptoms and how long they have existed.
He may ask the following questions:
- How long have you had no voice?
- Was there a lot of strain on your voice before the aphonia occurred?
- Are you a teacher/educator/speaker/singer/actor?
- Do you have any known respiratory or laryngeal diseases?
- Did you have an operation shortly before the loss of voice occurred, for example in the chest or throat area?
- If yes, was the operation performed under general anesthesia with artificial respiration?
- Do you smoke? If yes, how much and for how long?
- Do you drink alcohol? If yes, how much?
- Do you have a foreign body sensation in your throat?
- What medication are you currently taking?
He then examines the throat, 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 a viral or bacterial infection is suspected, the doctor takes a swab from the throat. This is then examined in the laboratory for possible pathogens.
If a tumor is suspected in the area of the larynx, imaging procedures are used, for example an ultrasound examination (US), computer tomography (CT) or magnetic resonance imaging (MRI).
