Non-organic Voice Disorders Research Articles

Exploring Symptoms of Gastroesophageal Reflux in the Egyptian Patients with Non-Organic Voice Disorders

Abstract Background Gastroesophageal reflux disease (GERD) is an entity with heartburn, regurgitation, chest and stomach pain, and the feeling of gastric acid coming up. Aim of the Work This study aimed to explore symptoms of GERD in patients with nonorganic voice disorders using the Arabic version of Reflux Symptom Index (A-RSI). Subjects and Methods This study was applied on 50 Egyptian Arabic-speaking patients in the age range between 20 to 59 years old. Patients included were diagnosed with non-organic voice disorders according to the protocol of voice assessment used in the Phoniatrics outpatient clinic in Ain Shams University Hospitals. The participated patients were asked to fulfill the ARSI questions and their answers were related to their age, gender, duration of their voice symptoms, and the overall grade of their dysphonia as assessed by the GRBAS scale. Results Analysis of the answers of the participated patients to the A-RSI, revealed that only 40% of patients had a total score of the A-RSI above 13. This indicates that the participated patients with non-organic voice disorders have symptoms of GER. There was an insignificant correlation between the scores of the A-RSI and the age, gender, and duration of voice symptoms. The total score of A-RSI is indirectly related to the overall grade of dysphonia of the participated patients. Conclusion Patients with non-organic voice disorders have symptoms of GERD, however these symptoms are not related to the duration of their voice symptoms and related indirectly to the overall grade of their dysphonic voices. GER may be a contributing etiological factor in non-organic voice disorders but need to be confirmed by further assessment.

Reflux symptoms and vocal characteristics in adults with non-organic voice disorders.

Laryngopharyngeal reflux (LPR) is prevalent and can lead to voice disorders, but its diagnosis is difficult, because of limited correlations between clinical symptoms and organic pathology. Various tools and methods have been explored to aid a diagnosis of LPR. To investigate associations between reflux symptoms, acoustic-, perceptual-, and physical vocal characteristics, glottal function index (GFI), and vocal handicap index (VHI) in adults with non-organic voice disorders. Data of 51 adults with non-organic voice disorders were collected, using a retrospective cohort explorative research design, at a private ear, nose and throat specialist practice in Gauteng, South Africa. Quantitative outcomes were compared between reflux symptom index (RSI), acoustic characteristics (jitter, shimmer and fundamental frequency [F0]), maximum phonation time, perceptual- (GRBASI) and physical vocal characteristics, GFI and VHI. The RSI showed positive fair correlations against GFI, VHIPand caffeine intake, indicating an increase in reflux symptoms with higher scores on the various measures. Moderate correlations were also found between GFI and VHIP, grade of hoarseness and jitter, strain and VHIP, strain and VHI total (VHIT) and between Asthenia and jitter. Very strong correlations were found within the various subsections of the VHI as well as between jitter and shimmer and between F0-male and physical symptoms of the VHI (VHIP). Results indicated associations between reflux symptoms, vocal characteristics, the GFI and the VHI. Based on the correlations found these tools used in conjunction could improve clinical diagnosis of LPR. Implications of these findings are promising, but further research is recommended.Contribution:This study contributes to the body of knowledge to support the accurate clinical diagnosis of LPR using subjective measures to determine LPR symptoms, as well as acoustic analysis.

Lesser Known Uses of γ-Aminobutyric Acid Analogue Medications in Otolaryngology.

In otolaryngology, γ-aminobutyric acid (GABA) analogues have been previously analyzed for their roles in neuropathic pain, chronic cough, tinnitus, and perioperative analgesia. The primary aim of this study is to comprehensively summarize and synthesize the existing evidence for lesser known uses of gabapentin and pregabalin in otolaryngology. A scoping review conducted of the available English-language literature was performed by two authors through April 1, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis criteria were followed, and a quality assessment of included studies was performed using the Methodological Index for Non-Randomized Studies. Ten studies met inclusion criteria. Three studies found that gabapentin may reduce gastrostomy tube usage and improve swallowing function in head and neck cancer patients undergoing radiation therapy (RT). Three studies suggested that gabapentin may help reduce opiate use when used as a primary analgesic in patients with radiation-induced mucositis. One study demonstrated that pregabalin-reduced trismus severity in patients with radiotherapy-induced trismus. One study demonstrated gabapentin may be useful in patients with phonasthenia. Two studies demonstrated that GABA analogues may be a useful adjunct in patients with globus pharyngeus in the context of likely laryngeal sensory neuropathy. The most promising potential uses for GABA analogues identified in this review are for improving swallowing, trismus, and narcotic overuse after RT. The benefit of GABA analogues for improving nonorganic voice disorders is also promising while the benefit for globus pharyngeus when possibly related to laryngeal sensory neuropathy is inconclusive. Laryngoscope, 132:954-964, 2022.

Determining Medical Urgency of Voice Disorders Using Auditory-Perceptual Voice Assessments Performed by Speech-Language Pathologists.

This study examined whether speech-language pathologist auditory-perceptual voice assessments can predict the medical urgency of voice disorders. Twenty speech-language pathologists (SLPs) evaluated 25 voice samples recorded during initial voice evaluations. Voice samples represented a range of dysphonia severity (mild-severe) balanced across patient diagnoses. Diagnoses included: benign lesions, laryngeal cancer, non-organic voice disorders, laryngeal edema (associated with LPR), and laryngeal paralysis or paresis. Laryngeal cancer and severe unilateral laryngeal paralysis were considered urgent disorders. While blinded to patient information, SLPs rated severity of voice quality, predicted patient diagnosis, and determined whether the patient should be seen urgently by a laryngologist. SLPs were then given basic medical history information and rated medical urgency of voice disorder a second time. On average, SLPs correctly identified 65% of urgent voices and 87% of nonurgent voices when blinded to patient information. Accuracy improved significantly to 86% for urgent voices with medical history information (P < .001) and decreased to 77% for nonurgent voices. Accuracy was better when severity of voice quality was severe for urgent voices and mild for nonurgent voices (P < .001). SLPs indicated that patient smoking history and severity of dysphonia were most influential in their decision making. Diagnostic accuracy of auditory-perceptual assessments was poor. SLPs identified 86% of medically urgent voice disorders when auditory perceptual assessments were combined with medical history information. Further work is needed to determine what medical history information is most crucial to rating accuracy and what speech tasks might best separate urgent and nonurgent patients.

The psychological correlates of non-organic voice disorders and minimal associated pathological lesions (MAPLS) of the vocal folds

Background: There are psychological aspects of all voices. Thus voice disorders may be of psychogenic background. All voice disorders can have a psychological element whether as a result or as a cause. It is uncertain whether personality and psychological problems lead to particular voice disorder, or that voice disorder contributes to psychological problems and personality effects. Aims/Objectives: to determine the psychological correlates of non-organic (functional) voice disorders and MAPLs.Material and Methods: (study group) consisted of 100 patients with a change of voice and not diagnosed with any previous psychological disorder. They was compared to another group (control group) which included 50 individuals with no change of voice. Each individual of both groups were subjected to full voice evaluation protocol, The Voice Handicap index and psychological evaluation with (Eysenck Personality Questionnaire, Symptom Chick List 90-Revised and Toronto Alexithymia Scale-20)Results: the psychological problems plays a role in the dynamics of the voice problems. The recognition of such psychological effects may contribute to more adequate diagnosis and therapy of patients with persisting voice.Conclusions and Significance: the personality and psychological domains may be part of the clinical profile for a subset of patients with non-organic voice disorders and MAPLS.

From Voice Clinic to Operating Room: Are We Out of Tune?

Introduction: To determine the consistency and accuracy of preoperative diagnosis in the voice clinic with intraoperative diagnosis and to suggest a standardized laryngeal examination protocol in the UK that is supported by evidence-based findings.Method: From January 2011-September 2014, 164 patients were referred to the Multidisciplinary Team voice clinic and diagnosed with laryngeal pathology that required phonosurgery. The visualization (videostrobolaryngoscopy) in clinic was performed using either rigid laryngoscope or a video-naso-laryngoscope. Intraoperatively, laryngeal visualization and surgical procedure was conducted using Storz Aida HD system, 10-mm rigid laryngoscope 0° or 5-mm rigid laryngoscope 0°/30° and a Zeiss S7 microscope.Results: Of the 164 patients seen in the multidisciplinary voice clinic, 86 clinic diagnoses were confirmed intraoperatively (52.4%), 15 patients had the diagnosis confirmed intraoperatively with additional lesion found (9.1%). The clinic diagnosis changed intraoperatively in 63 cases (38.4%). 61 (37.2%) patients seen in the voice clinic were diagnosed with cyst, in 39.3% the diagnosis was confirmed intraoperatively with 5 cases (8.2%) having an additional diagnosis. Twenty (12.2%) patients were diagnosed with polyps, with 80% confirmation intraoperatively; 3 patients (10%) had an additional diagnosis.Conclusion: Videolaryngostroboscopy imaging of the larynx provides an outpatient tool for accurately diagnosing more than 50% of laryngeal pathologies when interpreted by multidisciplinary voice clinicians. However direct laryngeal examination under general anesthesia remains the gold standard when obtaining accurate diagnoses of laryngeal pathology. Patients diagnosed with nonorganic voice disorders should be considered for direct laryngoscopy under general anesthetic should they fail to respond to conservative management.

Internal Validation of the Acoustic Voice Quality Index version 03.01 und Acoustic Breathiness Index

Acoustics might have the potential to objectify voice quality (eg, hoarseness and breathiness). The Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) revealed sufficient valid and reliable results in the evaluation of voice quality. The aim of the present study is to validate the recent version of AVQI 03.01 and ABI in their internal validation. The responsiveness of change is evaluated on the hoarseness and breathiness severity after voice therapy. In total, 84 voice samples of continuous speech and sustained vowel [a:] before and after a voice therapy were used. All 42 subjects presented organic and nonorganic voice disorders and various degrees of dysphonia severity before and after behavioral voice therapy. The voice samples were judged by three voice experts using the RBH-scale, which is based on the GRBAS-scale. The intra-rater reliability was high for hoarseness (mean kappa = 0.76) and breathiness (mean kappa = 0.69).The inter-rater reliability was lower for both voice quality characteristics and ranged between kappa = 0.27 to 0.29. A strong correlation was identified between the perceived rating of hoarseness and breathiness and AVQI and ABI before and after voice therapy (r = 0.715, p < 0.01, and r = 0.712, p < 0.01, respectively). Additionally, no significant differences were revealed. The present results showed that AVQI version 03.01 und ABI had a high internal validity to assess voice changes after voice therapy. AVQI and ABI are two valid and robust voice measures to objectify hoarseness and breathiness.

Functional Hoarseness in Children: Short-Term Play Therapy With Family Dynamic Counseling as Therapy of Choice

Children with nonorganic voice disorders (NVDs) are treated mainly using direct voice therapy techniques such as the accent method or glottal attack changes and indirect methods such as vocal hygiene and voice education. However, both approaches tackle only the symptoms and not etiological factors in the family dynamics and therefore often enjoy little success. The aim of the "Bernese Brief Dynamic Intervention" (BBDI) for children with NVD was to extend the effectiveness of pediatric voice therapies with a psychosomatic concept combining short-term play therapy with the child and family dynamic counseling of the parents. This study compares the therapeutic changes in three groups where different procedures were used, before intervention and 1 year afterward: counseling of parents (one to two consultations; n = 24), Brief Dynamic Intervention on the lines of the BBDI (three to five play therapy sessions with the child plus two to four sessions with the parents; n = 20), and traditional voice therapy (n = 22). A Voice Questionnaire for Parents developed by us with 59 questions to be answered on a four-point Likert scale was used to measure the change. According to the parents' assessment, a significant improvement in voice quality was achieved in all three methods. Counseling of parents (A) appears to have led parents to give their child more latitude, for example, they stopped nagging the child or demanding that he/she should behave strictly by the rules. After BBDI (B), the mothers were more responsive to their children's wishes and the children were more relaxed and their speech became livelier. At home, they called out to them less often at a distance, which probably improved parent-child dialog. Traditional voice therapy (C) seems to have had a positive effect on the children's social competence. BBDI seems to have the deepest, widest, and therefore probably the most enduring therapeutic effect on children with NVD.

Women's voices: Lost or mislaid, stolen or strayed?

It is estimated that disorders of voice affect 3–4% of people from all strata of Australian society and while some voice disorders may be caused by organic conditions, most patients are troubled by non-organic or functional voice disorders (FVD). As professionals dealing with these problems, we wonder about the role of strong negative emotions arising from stressful life experiences preceding onset, or dispositional factors that may influence ways in which an individual responds to such incidents. We wonder too, how these complex processes may be inter-related, and if this may account for one person misusing or damaging the voice, while another loses the voice altogether. Evidence for the possible relationship between negative emotions arising out of stressful events and onset of FVD in women is briefly presented. The findings suggest that women with FVD may have difficulty in the processing of negative emotions, and when considered in a wider socio-cultural perspective, it is proposed that some have temporarily lost their voices, while others have been rendered powerless and had their voices stifled. These findings serve as the foundation for a broader discussion about the possible implications for the speech pathology profession which might be at risk of losing its voice.

Retrospective study of 116 patients with non-organic voice disorders: efficacy of mental imagery and laryngeal shaking

To report the short- and long-term results of two techniques (mental imagery and manual shaking of the larynx) in patients with non-organic dysphonia or aphonia. Retrospective review of patient records, plus follow-up survey (questionnaire). Academic teaching hospital. One hundred and sixteen patients with moderate to severe non-organic dysphonia or aphonia. Cure (i.e. normal voice) and improved voice quality, judged by clinicians and patients. One hundred (86 per cent) of the 116 patients were cured. Ninety-four (81 per cent) patients regained their normal voice within one therapy session. The follow-up survey revealed that 43 of the 87 (49 per cent) patients who responded had not had a relapse since therapy ended. Of those patients suffering relapse, 15 successfully applied mental imagery in order to retrieve their voice, compared with three patients who applied shaking of the larynx. Mental imagery, combined if necessary with manual therapy, is an effective therapeutic technique in patients with non-organic voice disorders.

The Relationship Between Perceptual Evaluation and Objective Multiparametric Evaluation of Dysphonia Severity

The purpose of this study was to investigate the usefulness of the Dysphonia Severity Index (DSI) as an objective multiparametric measurement in assessing dysphonia. The DSI was compared with the score on Grade of the GRBAS scale. Investigated was also whether the DSI is related to severity of dysphonia, which was represented by different diagnosis groups. Furthermore, it was investigated whether the DSI can differentiate between a group of patients and a control group. A total of 294 patients with different voice pathologies were included. A control group consisted of 118 volunteers without any voice complaints. The voices of all participants were perceptually evaluated on Grade, and the DSI was measured. The groups of patients with voice complaints have a lower DSI and higher scores on Grade than the control group. The DSI was significantly lower when the score on Grade was higher. The DSI discriminates between patients with nonorganic voice disorders, vocal fold mass lesions, and vocal fold paresis/paralysis. To determine whether the DSI discriminates between patients and controls, the sensitivity and specificity for different DSI cutoff points were calculated. With a DSI cutoff of 3.0, maximum sensitivity (0.72) and specificity (0.75) were found. We conclude that the DSI is a useful instrument to objectively measure the severity of dysphonia.

Neurovegetative symptoms and complaints before and after voice therapy for nonorganic habitual dysphonia

In a previous study, female patients in all age categories with a nonorganic dysphonia were found to report significantly more autonomic symptoms and complaints than healthy controls. This could not be confirmed for the male subgroup. The present study is to corroborate and nuance this observation by investigating larger groups, and to determine if, after voice therapy, the number of autonomic symptoms and complaints-particularly those ones that have no obvious relation to voice function-decreases. It is a prospective study with a matched control group; 184 patients with nonorganic dysphonia and 126 normal controls answered a questionnaire of 46 questions with 3 subsets and a consistency control. One hundred and one patients received functional voice therapy and completed the questionnaire before and after treatment. A matched control group of 42 normal subjects also filled in the questionnaire two times, with an interval of about 6 months. Neurovegetative symptoms and complaints-voice related and not related-are reported in highly significant excess by patients (especially but not exclusively females) with habitual nonorganic voice disorder. After therapy, there is a highly significant reduction in the number of autonomic symptoms and complaints (related or not related to voice), to such an extent that patients report on average no more general neurovegetative symptoms and complaints than healthy controls (even less). The number of neurovegetative symptoms and complaints connected with voice function is also strongly reduced in patients after therapy, but remains in significant excess when compared with controls.

Die Kehlkopfkonfiguration beim Flüstern

The purpose of the study was to assess glottal and supraglottal configurations during whispering in comparison to habitual phonation and to visually estimate to what extent force is exerted onto the vocal fold epithelium during whispering. Is whispering a good compromise between preservation of epithelium and permission to communicate orally, e. g. postoperatively? We investigated on 100 patients with organic or non-organic voice disorders. Patients with vocal fold immobility and patients with organic lesions large enough to impede glottal closure were excluded. Videolaryngoscopy and stroboscopy was performed via flexible endoscopy. During fiberoscopy the patients were asked (i) to phonate and then whisper a series of vowels in various loudness levels and (ii) to count to 10 voiced and whispered in various loudness levels. The extent of vocal fold adduction and supraglottal configuration were assessed and whispering compared with voiced phonation. Interindividual differences in glottal and supraglottal configuration during whispering were seen. The two different and most frequently seen glottal area patterns were determined by the position of the vocal processes - either adducted or abducted. Adduction resulted in sole cartilaginous triangle formation or 'kissing processes', abduction in ligamentous and cartilaginous triangle. Another surprising result was that with increasing loudness either a narrowing or widening of glottal and supraglottal structures was visible. There are different patterns of glottal and supraglottal configuration during whispering. Although the vocal folds can show partial or total contact over the membranous parts, the lack of additional vibration of the vocal folds suggests that epithelial forces are smaller than with additional vibratory shear stress. Thus, whispering may be considered and allowed for postoperative communication purposes, when patients follow instructions for low-effort whispering.

An Update in Thinking About Nonorganic Voice Disorders

To describe and evaluate psychosocial factors in nonorganic voice disorders (NVDs). Nonorganic voice disorders are presumed to be the result of increased muscular tension that is caused to varying extents by vocal misuse and emotional stress. It is therefore necessary to include both of these in the diagnosis and treatment of patients with voice disorders. Clinical survey. Academic tertiary referral center. To evaluate psychosocial factors in NVDs, a sample of 74 patients with NVDs was examined psychologically using the Giessen Test and Picture Frustration Test. The results were compared with a control group of 19 patients with an organic dysphonia (vocal cord paralysis). Six scales of the Giessen Test (social response, dominance, control, underlying mood, permeability, and social potency), 3 reaction types of the Picture Frustration Test (obstacle dominance, ego defense, and need persistence), and 3 aggression categories of the Picture Frustration Test (extrapunitivity, intropunitivity, and impunitivity). The most striking significant difference between the 2 groups was that in conflict situations, patients with NVDs sought a quick solution or expected other people to provide one, which prevented them from understanding the underlying causes of the conflict. Only if the psychosocial aspects are taken into account can patients with NVD be offered a therapy that treats the causes of the voice disorder. It must be decided individually whether and when a voice training approach or a more psychological-psychotherapeutical approach is preferable.

Voice Research and Treatment: A UK Perspective

Voice Research and Treatment: A UK Perspective

Stress and distress in non-organic voice disorder.

Non-organic voice disorders are characterised by an impaired voice sound, and/or reduced vocal capacity, and/or laryngeal sensory disturbances, all in the absence of causal organic laryngeal pathology. Psychogenic causes, a "psychological disequilibrium", and an increased tension of the laryngeal muscles are presumed to be one end of the spectrum of possible factors leading to the development of the disorder. In making a diagnosis, perceptive and acoustic methods for voice analysis are used in addition to the ENT-examination and the laryngostroboscopy. An assessment of the degree to which the patient feels him/herself subjectively affected by the voice disorder also plays an important role. If the history reveals any indication of psychosocial stress or conflict, the patient is offered psychological consultations. These conflicts seem less often to be deep rooted psychopathological problems but rather daily anxieties, failures, injuries, annoyances, disappointments regarding the sufferer him/herself and others, the non-fulfillment of desires, feelings of inadequacy and of lack of self-confidence. The patients may find it difficult to speak about conflicts and feelings, and they follow social conventions to an excessive extent. In frustrating situations patients tend to react aggressively towards themselves rather than towards others and are too quick in seeking a solution to any problem that may arise. The role of the voice as a "barometer of emotion", where a disorder may be regarded as a sign of emotional stress, has to be taken into consideration before starting a therapy: If the non-organic voice disorder is obviously due to vocal misuse and muscle tension, a more symptom-orientated voice therapy may be favoured. If psychosocial stress seems to play a greater role, additional counseling may be necessary. Only by using this approach can the patient be offered a therapy which goes into the causes and thereby addresses the whole person.

Stress and distress in non-organic voice disorder.

Non-organic voice disorders are characterised by an impaired voice sound, and/or reduced vocal capacity, and/or laryngeal sensory disturbances, all in the absence of causal organic laryngeal pathology. Psychogenic causes, a "psychological disequilibrium", and an increased tension of the laryngeal muscles are presumed to be one end of the spectrum of possible factors leading to the development of the disorder. In making a diagnosis, perceptive and acoustic methods for voice analysis are used in addition to the ENT-examination and the laryngostroboscopy. An assessment of the degree to which the patient feels him/herself subjectively affected by the voice disorder also plays an important role. If the history reveals any indication of psychosocial stress or conflict, the patient is offered psychological consultations. These conflicts seem less often to be deep rooted psychopathological problems but rather daily anxieties, failures, injuries, annoyances, disappointments regarding the sufferer him/herself and others, the non-fulfillment of desires, feelings of inadequacy and of lack of self-confidence. The patients may find it difficult to speak about conflicts and feelings, and they follow social conventions to an excessive extent. In frustrating situations patients tend to react aggressively towards themselves rather than towards others and are too quick in seeking a solution to any problem that may arise. The role of the voice as a "barometer of emotion", where a disorder may be regarded as a sign of emotional stress, has to be taken into consideration before starting a therapy: If the non-organic voice disorder is obviously due to vocal misuse and muscle tension, a more symptom-orientated voice therapy may be favoured. If psychosocial stress seems to play a greater role, additional counseling may be necessary. Only by using this approach can the patient be offered a therapy which goes into the causes and thereby addresses the whole person.

Laser projection in high-speed glottography for high-precision measurements of laryngeal dimensions and dynamics

The detection of metric dimensions of laryngeal structures yields valuable information for both clinical and research purposes. The use of a laser projection system combined with a high-speed camera system enables the derivation of absolute spatial dimensions of the larynx. Vocal fold length, vibratory amplitudes and velocity can be derived. This was shown on 13 female and 9 male larynges during phonation of a vowel at different pitches. The vocal fold length, the amplitude of oscillation and the velocity of vibration were analyzed in between pitches of 119 to 236 Hz in the male group and 181 to 555 Hz in the female group. The vocal folds' length ranged from 8.4 to 14.3 mm in the male group and from 7.7 to 15.6 mm in the female group. Corresponding amplitudes varied from 0.33 to 1.24 mm (male) and from 0.38 to 0.82 mm (female). The maximal velocity of vibration was between 0.48 and 0.85 m/s in males and between 0.47 and 1.3 m/s in females without showing significant correlation between each parameter. The described technique enables the detection of absolute spatial laryngeal dimensions of female and male subjects at different pitches. Dynamic processes such as velocity of vibration can be quantified. The detection of metric data serves to optimize biomechanical model computations and provides valuable information in diagnostics and interpretation of organic and non-organic voice disorders.

Management of non-organic voice disorders: physiological bases of Accent Method for non-organic voice disorders

The purpose of this study is to examine the physiological characteristics of the Accent Method of voice therapy. To study the effect of accentuation in the Accent Method, the increase in airflow rate (Airflow), fundamental frequency (F0) and sound pressure level (SPL) caused by accentuation were simultaneously measured by means of the Nagashima Phonatory Function Analyzer PS-77H.Participants were five female patients with functional dysphonia, two normal professional subjects and two normal untrained subjects. The results are summarized as follows:(1)The five patients with functional dysphonia showed significantly greater increases in F0, SPL and Airflow in the accentuations after voice therapy than before voice therapy.(2)In the normal group, the professionally trained subjects showed significantly greater increases in F0 and SPL in the accentuations than untrained and pathological subjects before voice therapy. There was no difference in increases in Airflow in the accentuations among the professionally trained, untrained and pathological subjects after voice therapy.(3)The increases in F0 and SPL after voice therapy were greater than before voice therapy. All patients could increase the accentuations by means of abdominal breathing. This could be explained by the fact that the Accent Method caused a greater flexibility of controlling phonation. Furthermore, all patients showed efficient voice production after voice therapy.

Psychogenic stress as a possible etiological factor in non-organic dysphonia

Psychogenic background of non-organic dysphonia has been suspected for some time. The purpose of this study is to assess cases of non-organic voice disorders in order to elucidate the role of psychogenic stress in the pathogenesis of this clinical entity. To reach our goal, 100 non-organic voice disorder patients were subjected to both voice and psychiatric protocols of assessment and the results obtained were compared with the results of 50 normal individuals whom subjected to the same protocols of assessment. The results showed that there was a highly significant difference between both groups as regards the scales of psychiatric tests. Conclusion: there is evident psychogenic background for some types of non-organic voice disorders, namely, incomplete mutation, phonasthenia and non-organic aphonia. This may necessitate a combined therapy program of behavior readjustment voice therapy as well as psychiatric management for these cases to get best results and avoid relapse.