From the Guidelines
Dysphonia is a symptom of various underlying diseases, including head and neck cancer, neurologic, gastrointestinal, rheumatologic/autoimmune, allergic, pulmonary, musculoskeletal, psychological, traumatic, and infectious conditions, as stated in the clinical practice guideline: hoarseness (dysphonia) (update) executive summary 1. The causes of dysphonia can be categorized into several groups, including:
- Neurological conditions, such as vocal fold paralysis, spasmodic dysphonia, essential tremor, Parkinson’s disease, amyotrophic lateral sclerosis, and multiple sclerosis
- Gastrointestinal conditions, such as reflux and eosinophilic esophagitis
- Rheumatologic/autoimmune conditions, such as rheumatic arthritis, Sjögren’s syndrome, sarcoidosis, amyloidosis, and granulomatosis with polyangiitis
- Allergic conditions
- Pulmonary conditions, such as COPD
- Musculoskeletal conditions, such as muscle tension dysphonia (MTD), fibromyalgia, and cervicalgia
- Psychological conditions, such as functional voice disorders
- Traumatic conditions, such as laryngeal fracture, inhalational injury, iatrogenic injury, and blunt/penetrating trauma
- Infectious conditions, such as candidiasis It is essential to identify the underlying cause of dysphonia to provide appropriate treatment and prevent delayed diagnosis, particularly in cases of head and neck cancer, as highlighted in the clinical practice guideline: hoarseness (dysphonia) (update) executive summary 1. Additionally, certain lifestyle factors and behaviors can contribute to the development of dysphonia, such as:
- Smoking and secondhand smoke
- Overusing or straining the voice
- Excessive throat clearing and coughing
- Alcohol and caffeine consumption
- Use of drying medications As recommended in the clinical practice guideline: hoarseness (dysphonia) (update) 1, clinicians should advise patients to avoid these factors and promote vocal health through proper hydration, avoiding vocal strain, and prompt treatment of respiratory infections. Clinicians should identify dysphonia in patients with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL), and assess the patient by history and physical examination for underlying causes of dysphonia and factors that modify management, as stated in the clinical practice guideline: hoarseness (dysphonia) (update) 1.
From the Research
Causes of Dysphonia
The causes of dysphonia can be varied and complex. Some of the common causes include:
- Acute laryngitis, which is the most common cause of dysphonia, with the majority of cases lasting fewer than 3 weeks 2
- Chronic laryngitis, laryngopharyngeal reflux, muscle tension dysphonia, benign vocal fold lesions, vocal fold paresis or paralysis, and spasmodic dysphonia, which can cause longer duration of symptoms 2
- Laryngeal malignancy, which is uncommon, but can be a serious underlying etiology, with major risk factors including smoking and concurrent alcohol use 2
- Vocal cord disorders, such as vocal cord atrophy, benign vocal cord lesions, and vocal cord paresis or paralysis, which can present with dysphonia, respiratory symptoms, and stridor 3
- Neurogenic disorders, such as central dysphonias, spasmodic dysphonia, and dysphonia caused by myasthenia gravis, which can cause dysphonia due to primary neurogenic disorders 4
- Psychogenic disorders, such as psychogenic aphonia and psychogenic dysphonia, which can cause dysphonia due to primary psychogenic disorders 4
- Somatic disorders, such as dysphonia caused by insufficiency of vocal cords, oedema of vocal cords, and laryngitis, which can cause dysphonia due to primary somatic disorders 4
Age-Related Causes of Dysphonia
The causes of dysphonia can also vary with age. For example:
- In adults aged 65 and older, the most common etiologies of dysphonia are vocal cord atrophy and neurologic dysphonia 5
- In adults under 65, the most common etiologies of dysphonia are benign vocal cord lesions and muscle tension dysphonia 5
- Aging-related voice disorders are often due to disease processes associated with aging, rather than physiologic aging alone, and can include central neurological disorders, benign vocal fold lesions, inflammatory disorders, laryngeal neoplasia, and laryngeal paralysis 6