Hyperfunctional Dysphonia: Causes, Symptoms & Treatment

Hyperfunctional dysphonia is a voice disorder without an organic cause. Patients habitually overuse the muscles involved in vocalization. During speech therapy, they learn to normalize their voice production in a targeted manner.

What is hyperfunctional dysphonia?

Articulation has a vocal part to some degree. This vocal part of articulation is impaired in dysphonia. Depending on the findings and the degree, the voice in hyperfunctional dysphonia sounds hoarse to raspy, is breathy or occupied. The timbre of the voice, the pitch of the articulation and the volume of the articulated sounds can be varied by a patient with dysphonia only with restrictions. Patients with dysphonia often complain of dryness and a foreign body sensation in the throat. Compulsive throat clearing is the result. There are several subgroups of dysphonia. One of them is hyperfunctional dysphonia. This speech disorder results from regular unintentional and excessive contraction of the voice production muscles. In addition to the phonation musculature, the respiratory musculature and the articulation musculature as well as the throat musculature are involved in voice formation. Hyperfunctional dysphonia is thus a voice disorder resulting from overuse of these muscles.

Causes

Dysphonia has either organic or functional causes. Organic causes include inflammation, paralysis, neoplasms, and gastric acid reflux. Only rarely are causative laryngeal injuries or malformations of the larynx present. Functional dysphonia, on the other hand, is caused by overuse, such as voice-damaging speech habits. Such dysphonia is also called habitual dysphonia. Since the cause of hyperfunctional dysphonia corresponds to an overload of the muscles involved in articulation, this type of dysphonia is often habitual functional dysphonia. The designation as “hyperfunctional” provides information about the cause as well as the effect. In hyperfunctional dysphonia, the overload of the muscles leads to an excessive use of force during articulation and in this way changes the sound of the articulated sounds. In addition to the causes mentioned above, factors such as alcohol consumption and nicotine use can contribute to hyperfunctional dysphonia or exacerbate existing dysphonia.

Symptoms, complaints, and signs

Patients with hyperfunctional dysphonia suffer from a number of different symptoms that may be more or less severe. In most cases, their voice sounds harsh, occupied, and diplophonic. Many of those affected produce multiple frequencies at the same time and experience their voice disorder additionally associated with a compulsion to clear their throat and swallow. When swallowing empty, they are plagued by a lumpy feeling. Their hoarseness increases depending on the vocal stress. Occasionally, pain is present in the laryngeal region. There is a foreign body sensation in their throat, often described as mucus in the throat. Some of the patients experience a sense of shame or at least unpleasant feelings towards their own voice production. In some cases, sufferers try to speak as little as possible from then on. In exceptional cases, the lack of flexibility of the voice leads to misunderstandings in social settings. For example, intonation and its variations play a key role in social speech acts such as irony or sarcasm. Hyperfunctional dysphonia can thus make it difficult to convey specific interpretations of what is being articulated.

Diagnosis and course of the disease

In hyperfunctional dysphonia, posteriorly lowered epiglottis and reddened vocal folds are landmark diagnostic criteria. Another criterion is bulging pocket folds and dorsally located final insufficiency. A long closing phase and low amplitudes of vocal fold oscillations may also be relevant for the diagnosis. The physician thus makes the diagnosis by a voice test and combines this test with gaze-diagnostic assessment of the articulation-involved structures. The prognosis for people with hyperfunctional voice disorder is favorable. Organic voice disorders, by comparison, have a much less favorable prognosis and often leave permanent voice changes. In contrast, hypo- and hyperfunctional dysphonia are fully curable.

Complications

One of the most common forms of voice disorder is hyperfunctional dysphonia, which usually occurs due to uneconomic use of the voice or after periods of colds. The patient uses too much pressure in voice production, straining the muscles excessively and overloading them over time. There are promising therapies that are guided by voice therapists and speech therapists. However, complications are possible. A hyperfunctional voice disorder caused by incorrect use can develop into an organic voice disorder in the course of time. Among the most common changes are vocal fold nodules, also called crying nodules. In this case, small thickenings form on the vocal folds, which in the initial stage can still be treated by vocal exercises. The longer they exist and the firmer they are, the more likely they are to require surgical intervention followed by voice rest and therapy. Furthermore, hyperfunctionally strained vocal folds are susceptible to infections and become inflamed quickly. Recurrent hoarseness and voicelessness are the consequences. The swollen vocal cords sometimes also cause shortness of breath. In extremely overstrained voices, it is possible that the so-called pocket fold voice develops. The pocket folds are located directly above the actual vocal cords. When they stand in for the normal voice, the voice sounds strongly compressed, rough, hoarse and very deep. Psychological complications are also to be expected. It is not uncommon for patients to be professionally dependent on a good voice. If it fails again and again, fears for the future are the result.

When should you go to the doctor?

Changes in vocalization indicate diseases that often require treatment. If the abnormalities persist over a long period of time or increase in intensity, a doctor must be consulted. Persistent hoarseness without an apparent cause should be investigated and treated. Constant throat clearing, difficulty swallowing or a dry mouth are signs that should be investigated. If there is a foreign body sensation in the throat, discomfort in the throat area, or changes in the mucous membranes in the throat, a physician should be consulted. If there is pain, a feeling of tightness or loss of appetite, it is recommended that the symptoms be investigated. Pain medication should only be taken in consultation with a physician. If food is refused and there is severe weight loss, the affected person needs help. There is a threat of an undersupply of the organism. Sleep disturbances, nervousness or general malaise should be investigated as soon as they persist for several weeks. If affected persons suddenly refuse to speak or severely restrict their articulation, a check-up should be initiated. If the voice changes lead to behavioral problems, withdrawal from the social environment or a depressed mood, a visit to the doctor is necessary. If there are feelings of shame, anxiety or melancholic behavior, it is advisable to see a doctor or therapist.

Treatment and therapy

All functional voice disorders require awareness and, most importantly, training. Awareness of the act of articulation and self-monitoring during articulation form the basis for working on vocalization during training. All functional dysphonia are treated within the framework of targeted voice therapy. Phoniatrists, respiratory teachers, speech and voice teachers or speech therapists are involved in the therapy. This interdisciplinary team of experts teaches patients disciplines such as respiratory rhythm-adapted phonation. The patient is educated about the physiology of vocalization so that he can consciously monitor himself in the act of articulation. Awareness of the causes of his or her voice disorder helps the patient pay particular attention to the volume of his or her own voice while speaking. Because habitual hyperfunctional dysphonia is a voice disorder by habit, therapy can take a long time. Habits can only be changed with consistent and regularly targeted training over a greater or lesser period of time. Bit by bit, the patient gets used to speaking in a normal loud voice again. He learns to use the breathing, phonation, throat and articulation muscles less. Unlike organic voice disorders, no invasive treatments are used for functional and hyperfunctional voice disorders.The patient is thus spared any surgical procedures. During the period of therapy, patients are usually advised to abstain from nicotine and alcohol.

Outlook and prognosis

The prognosis of hyperfunctional dysphonia is described as favorable. Since there is no organic cause of the voice disorder, a permanent cure of the symptoms is possible. In many cases, this requires good and successful therapy so that the causes can be worked out and changed. The treatment path can last from weeks to several years. The underlying cause as well as the patient’s willingness to cooperate in a therapy are decisive for this. Spontaneous healing is possible at any time. Likewise, if the treatment plan is not followed and the triggering overload is re-lived, the symptoms may regress. For lasting freedom from symptoms, the patient must learn to adapt his or her vocalization to the needs and possibilities of the organism. With helpful tips for the handling of the voice, hints for the change of the life-style as well as sufficient explanations about the function mode of the vocalization a consciousness sensitivity is to be reached with the concerning. In the long run, this leads to a sustained recovery as well as the favorable prognosis. In addition, early warning signals are learned so that the patient can initiate changes and optimizations as quickly as possible if the complaints recur. The later therapy takes place, the more difficult it is to relearn how to speak. Nevertheless, recovery is possible even in these cases.

Prevention

Hyperfunctional dysphonia can be prevented. In addition to nicotine abstinence and alcohol abstinence, preoccupation with the act of articulation can be understood as a preventive measure. Those who are aware of the physiological act of vocalization are less inclined to overuse the musculature involved.

Aftercare

Aftercare for hyperfunctional dysphonia initially focuses on adjusting the voice to the physical capabilities and needs. For those affected, this means rethinking lifestyle habits. Medical advice is primarily related to the use of the patient’s own voice and to explanations of vocal function. The increased sensitivity of patients helps to recognize any warning signals at an early stage. Deteriorations or changes can be detected correspondingly quickly. If necessary, another visit to the doctor can then help to adjust the therapy accordingly. Follow-up care often includes logopedic treatment. This focuses on special exercises for the voice and also for speech. Through regular training, patients soon succeed in performing these exercises at home under their own responsibility. In this way, voice training continues after the therapy sessions. Other useful measures in connection with this direct aftercare are related to health awareness. Disturbing influences such as cigarette consumption and alcohol should be avoided as far as possible. As a result, not only the physical condition improves, but also the psychological status quo. Social communication also plays a certain role, as it ensures a better quality of life.

Here’s what you can do yourself

To improve his or her well-being despite hyperfunctional dysphonia, the patient’s self-help measures address both the physical and psychological symptoms of the condition. The usually unusual voice of those affected is conspicuous to outsiders and therefore often leads to feelings of shame among patients. In the worst case, social withdrawal and depression result. In order to maintain or improve their quality of life, patients deal openly with hyperfunctional dysphonia and inform those around them that they suffer from the condition. The acceptance shown helps those affected to cope with hyperfunctional dysphonia and supports their mental well-being. With regard to the physical complaints, the patient usually receives logopedic therapy, during which he or she learns various exercises for training the voice and speech. An essential factor for the success of logotherapy is the self-responsible implementation of the training sessions at home, since the therapy sessions alone are often not sufficient for a serious improvement.In addition, patients abstain from cigarette consumption and alcohol whenever possible, which not only improves their physical and psychological well-being but also has a positive effect on the course of hyperfunctional dysphonia.