Dysphonia is the inability to vocalize (loss of voice) due to a disorder of the larynx or its innervation. Dysphonic patients have a breathy sound resulting from abnormal apposition of the vocal cords.
Laryngitis is the most common cause of decreased voice volume, but laryngeal hypophonia may be based on other causes such as damage to the superior laryngeal nerve, nodules or polyps of the larynx or vocal cords, or carcinoma involving the larynx. Muscle paralysis or fatigability can produce hypophonia, which is produced after excessive speaking. When a patient presents with variable hypophonia and/or dysarthria, a disorder of the neuromuscular junction should be sought. Dysphonia should lead to an investigation of laryngeal disease, either primary or secondary to an abnormality of innervation.
Spasmodic dysphonia is a segmental dystonia and is usually nonprogressive. This unusual syndrome occurs in middle aged or elderly individuals. Spasmodic dysphonia involves dystonic spasms of the laryngeal muscles. In the most common form, the adductor type, the voice will be strained, high-pitched, and commonly punctuated by repetitive brief interruptions of speech. Singing, whispering, or changing the voice's pitch may sometimes help lessen the spasms. Less commonly, the voice has a whispering, breathy quality, due to abduction spasms of the vocal cords.
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