Dyskinetic Voice Disorder: Causes, Symptoms & Treatment

Incorrect vocal technique as well as harmful stress on the vocal folds often lead to dyskinetic voice disorder. In this case, the voice sounds rough or hotter and the patient complains of a scratchy throat or a feeling of pressure in the area of the larynx. Therapeutic measures help to learn a proper vocal technique and to load the vocal folds correctly when speaking.

What is a dyskinetic voice disorder?

The group of dyskinetic voice disorder includes all functional voice disorders that do not have their cause in organic damage. Rather, this disorder is caused by improper vocal technique, improper stress on the vocal folds, or overuse of the voice. It occurs as hyper- or hypofunctional dysphonia and manifests itself in an altered voice quality. The voice usually sounds remarkably rough and hoarse. Both children and adults are affected by the disease. However, it often occurs in people who put a lot of strain on their voice. Teachers and educators are a classic example. After all, these professions have to talk long and loudly in a high noise level. In addition, children who shout more than average tend to develop this voice disorder. It is not uncommon for women to develop vocal fold nodules in the course of the disease.

Causes

Dyskinetic voice disorder has several causes. However, since it is a functional disorder of the vocal apparatus, no organic damage is responsible for the disorder. In most cases, the vocal tools have only limited functionality. The most common reason is strong physical stress on the vocal folds, as occurs with shock or pain. As a result, the vocal folds do not arrange themselves correctly when speaking (so-called phonation position) or they press tightly together. Hyperfunctional dysphonia is caused by excessive tension of the vocal folds during speech. On the other hand, excessive sparing of the vocal folds during speech leads to hypofunctional dysphonia. There are also harmful influences that additionally strain the voice and promote dyskinetic voice disorder. These include, for example, alcohol and nicotine as well as frequent crying.

Symptoms, complaints and signs

In patients with hyperfunctional dysphonia, the pouch folds are bulging and the epiglottis is noticeably low. Consequently, the vocal cords are close together and the laryngeal inlet is narrowed. In contrast, hypofunctional dysphonia is characterized by a high epiglottis and incompletely contiguous vocal cords. In addition, in this case there is a shortening of the duration of the sound. Affected individuals usually complain of a feeling of pressure in the larynx and a scratching in the throat. Even the slightest strain on the vocal apparatus causes a noticeably hoarse and rough voice. In women, vocal fold nodules also sometimes form.

Diagnosis

If a dyskinetic disorder is suspected, an otolaryngologist should be consulted immediately. He or she will first evaluate the patient’s voice, as its change is the leading symptom of the functional voice disorder. It often also provides initial information about possible causes of the disorder. The physician conducts an extensive interview with the affected person. This includes information about the person’s occupation, possible allergies and medications taken. This is followed by an examination, during which the doctor pays attention to the breathing technique, the flow of speech and the use of language. In many cases, the diagnosis is supplemented by methods of laryngoscopy (laryngoscopy) and stroboscopy. They are used to determine or exclude organic damage. Based on the diagnosis, the physician initiates the necessary therapeutic measures. As a result, the disease usually takes a positive course. The incorrect use of the voice can be corrected and the dysphonia usually disappears. In children, the voice disorder often goes away on its own. However, long-lasting voice problems should also be treated professionally in them.

Complications

Dyskinetic voice disorder is a functional disorder of the speech apparatus. The voice appears hoarse or raspy, sometimes with scratchiness in the throat and discomfort in the larynx. If left untreated, symptoms may worsen. Dyskinetic voice disorder is sometimes caused by improperly directed vocal technique, overuse of the voice or vocal folds.It is helpful to improve vocal technique to a healthy level in order to reduce the strain on the speech apparatus. However, excessive understraining of the vocal folds (hypofunctional dysphonia) can also lead to dyskinetic voice disorders. People who have to speak a lot due to their job are affected by excessive strain on the voice. These include teachers, lecturers, educators, singers and telephone operators. Failure to treat the voice disorder can have existential consequences. Children who scream a lot in day care can also develop dyskinetic voice disorders. They must be taught to use their voice gently so that no permanent damage is done to the voice pattern. In the short term, sparing or inhaling with hot water will help. In the long term, however, speaking habits should be changed. First of all, an ENT physician should be consulted, who will then call in a speech therapist. The latter helps to teach harmonious and economical speech through therapeutic measures in the form of voice training. This includes improving the flow and use of speech as well as breathing exercises under professional guidance. Since alcohol, nicotine and frequent shouting increase the symptoms, these should be avoided.

When should you see a doctor?

If a dyskinetic voice disorder is suspected, a visit to the doctor is recommended. A scratchy throat and a feeling of pressure in the larynx area are clear warning signs that should be clarified quickly. This is especially true if the voice problems persist for a long time or are accompanied by other symptoms such as pain, difficulty swallowing or inflammation. With children, elderly and sick people, as well as patients with immunodeficiency, the doctor should be consulted immediately in case of complaints. People who speak little or overload the vocal folds are particularly at risk for dyskinetic voice disorder. Allergies and medications taken can also cause problems with the vocal folds. Harmful influences such as nicotine and alcohol are also among the risk factors and sufferers should consult an ear, nose and throat specialist if these factors apply. In the case of aforementioned complaints, the medical professional can first make a tentative diagnosis by assessing the patient’s voice and examining it for changes. Based on the diagnosis, the necessary treatment can then be initiated or the patient can be referred to a specialized specialist or clinic for voice band disorders.

Treatment and therapy

Dysphonia can be treated in a variety of ways. Depending on the cause, surgical or conservative methods are used. Therapeutic measures are preferred. If these are successful, surgery may eventually be avoided. Therapy often takes place with a speech therapist. The patient learns the correct use of the voice in training sessions. He also performs various speech and breathing exercises under professional guidance. These help the affected person to develop a vocal technique that is less stressful. If the patient has developed persistent vocal cord nodules, these are surgically removed if the therapy is not effective. Such surgery is followed by renewed voice therapy. Otherwise, the nodules can form again within a few days if the voice is used incorrectly. Depending on the severity of the disorder, psychological support may also be useful.

Outlook and prognosis

Dyskinetic voice disorder has a favorable prognosis. In speech therapy, the patient learns the proper techniques for optimal speech. Incorrect stress on the vocal cords, muscles, or problems with pronunciation are corrected through a variety of training and exercises. The treatment plan is adapted to the individual needs of the patient. A sense of achievement is encouraged and the joy of speaking is supported. Without therapy, problems or abnormalities in phonation often persist throughout life. In individual cases, the voice disorder worsens or the patient completely refuses to speak. In many cases, there is a lowered volume of speech, a speech defect, or a permanent accent. The best prognosis is given to patients who use psychotherapy in support of speech therapy. Often, obstacles to speech are tied to emotional or psychological inhibitions. They arise after traumas, during periods of strong challenges in life or due to unprocessed emotional processes.If the dyskinetic voice disorder is triggered by organic problems such as the formation of vocal nodules, surgery is performed to correct it. Following the surgery, voice therapy is prescribed immediately to re-learn how to voice. If this therapy is not taken up, voice disorder recurs as nodules form repeatedly.

Prevention

In children, dyskinetic voice disorder can be prevented or detected early. For this purpose, parents should pay attention to the speech development of their offspring and stop frequent crying. As soon as they notice any abnormalities in the voice, they should consult a doctor immediately. He or she can get to the bottom of the causes and initiate appropriate treatment. Those who have a voice-intensive profession (for example, educators, teachers or pastors) should also carefully monitor their voice use and attach great importance to proper vocal technique. Furthermore, it is advisable to avoid harmful influences such as alcohol and nicotine.

Aftercare

In most cases, the possibilities and measures of direct aftercare for this disease are severely limited or not available to the affected person at all. In this case, first and foremost, a quick and, above all, an early diagnosis should be made so that further complications or a further worsening of the symptoms do not occur. Self-healing cannot occur with this disease, so that treatment by a doctor must be carried out in any case. In most cases, the treatment of this disease is carried out through various therapies. The affected person usually has to visit a speech therapist, although many of the exercises from such therapies can also be performed at home. This may speed up the recovery of the affected person. Furthermore, parents should encourage the child with this disease and support him/her in the treatment in any case. Sensitive and loving conversations are also very useful, so that psychological upsets or depressions do not occur. However, the further course of the disease depends very much on the exact manifestation of the disease, so that no general prediction can be made. As a rule, however, this does not reduce the patient’s life expectancy.

What you can do yourself

Dyskinetic voice disorder is a functional voice disorder that is not due to organic causes, but to incorrect use of the vocal tools. If this condition is suspected, a specialist, preferably an otolaryngologist, should be consulted immediately. After a comprehensive examination of the vocal tools, especially the vocal cords, where nodules form very quickly, the patient is recommended therapeutic measures, which he or she should follow without fail. In the case of children, it is often enough to urge them to stop shouting loudly when playing. Parents who are unable to assert themselves with their children should quickly seek professional educational help. Adults also usually need to rest their voices for a while. This is especially true for professional frequent speakers such as teachers and educators. In the event of a dyskinetic voice disorder, this professional group must be prepared to be unable to perform their activities for some time. Physician-prescribed rest periods should be strictly observed. In addition, it is necessary to learn how to use the voice tools correctly in order to prevent the recurrence of a dyskinetic voice disorder. Usually, a speech therapist is consulted for this purpose, who executes speech and breathing exercises with the affected person and teaches them the correct use of the voice. It is essential to use the techniques learned to prevent relapse.