Comprehensive management of psychogenic dysphonia: a case illustration

A Comparison of Voice and Psychotherapeutic Treatments for Adults With Functional Voice Disorders: A Systematic Review

OBJECTIVE

To examine the effect of traditional voice therapy and cognitive therapy on the voice and client-wellbeing outcomes in adults with functional voice disorders (FVD).

METHODS

A systematic review of English articles was conducted using Medline (Ovid), Embase (Elsevier), CINAHL (Ebsco), The Cochrane Central Register of Controlled Trials (CENTRAL), PsychInfo (Ebsco) and Speechbite from inception to current date. Additional studies were identified through bibliographies and authors were contacted when further information was required from an article. All study designs were included with pretest/posttest outcome measures related to voice. Independent extraction of studies was completed by three authors using predefined data fields and quality assessment tools.

RESULTS

Outcomes of 23 studies (2 RCTs and 21 cohort or case studies) are summarised using a narrative style due to heterogeneity of interventions and outcome scales used. Overall research quality of included studies was low, with many cohort and case studies lacking controls, blinding and robust outcome measures.

CONCLUSIONS

There are some benefits to pairing cognitive behavioural therapy (CBT) with traditional voice therapy for FVD including improved voice quality, psychosocial wellbeing and prevention of relapse. It is feasible to train speech-language pathologists (SLPs) in CBT-enhanced voice therapy. Further high-quality research is needed, however, to guide the clinical implementation of CBT for the management of FVD.

Functional Speech and Voice Disorders: Case Series and Literature Review

Background

Functional disorders of speech and voice, subtypes of functional movement disorders, represent abnormalities in speech and voice that are thought to have an underlying psychological cause. These disorders exhibit several positive and negative features that distinguish them from organic disorders.

Methods and Results

We describe the clinical manifestations of functional disorders of speech and voice, and illustrate these features using six clinical cases.

Conclusions

Functional disorders of speech and voice may manifest in a variety of ways, including dysphonia, stuttering, or prosodic abnormalities. Given that these disorders have been understudied and may resemble organic disorders, diagnosis may be challenging. Appropriate treatment may be quite effective, highlighting the importance of prompt and accurate diagnosis.

Clinical Features of Psychogenic Voice Disorder and the Efficiency of Voice Therapy and Psychological Evaluation

OBJECTIVES

The aim of this study was to define the clinical features of psychogenic voice disorder (PVD) and explore the treatment efficiency of voice therapy and psychological evaluation.

METHOD

Fifty-eight patients who received treatment following the PVD diagnosis and had no organic or other functional voice disorders were assessed retrospectively based on laryngoscopic examinations and subjective and objective assessments. Epidemiological characteristics, accompanying organic and psychological disorders, preferred methods of treatment, and previous treatment outcomes were examined for each patient. A comparison was made based on voice disorders and responses to treatment between patients who received psychotherapy and patients who did not.

RESULTS

Participants in this study comprised 58 patients, 10 male and 48 female. Voice therapy was applied in all patients, 54 (93.1%) of whom had improvement in their voice. Although all patients were advised to undergo psychological assessment, only 60.3% (35/58) of them underwent psychological assessment. No statistically significant difference was found between patients who did receive psychological support concerning their treatment responses and patients who did not. Relapse occurred in 14.7% (5/34) of the patients who applied for psychological assessment and in 50% (10/20) of those who did not. There was a statistically significant difference in relapse rates, which was higher among patients who did not receive psychological support (P < 0.005).

CONCLUSION

Voice therapy is an efficient treatment method for PVD. However, in the long-term follow-up, relapse of the disease is observed to be higher among patients who failed to follow up on the recommendation for psychological assessment.

Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series

Introduction

Objective

Methods

Results

Conclusions

Disfonia psicogênica associada a outras doenças: desafio para o tratamento fonoaudiológico

TEMA: sucessos e dificuldades no tratamento de disfonia psicogênica. OBJETIVO: discutir as limitações da terapia fonoaudiológica para disfonia psicogênica associada a outras doenças. MÉTODO: foram utilizados protocolos de avaliação e registros de terapia para discussão do caso. RESULTADOS: a paciente chegou com importante alteração vocal e, após avaliação, diagnosticou-se disfonia psicogênica. O tratamento envolveu ativação vocal e modificação do ajuste fixado. Observaram-se mudanças positivas como estabilidade no padrão vocal, redução da rouquidão, aspereza, soprosidade e desconforto laríngeo e na qualidade de vida relacionada à voz, mas que não se sustentaram na medida em que houve piora dos outros problemas de saúde. CONCLUSÃO: o tratamento fonoaudiológico pode ser limitado, contudo desafiador, quando a disfonia psicogênica ocorre de maneira concomitante com outras doenças.