Definition

Loss of voice (also called aphonia) may take several different forms. You may have a partial loss of your voice and it may sound hoarse. Or, you may have complete loss of your voice and it may sound like a whisper. Loss of voice can come on slowly or quickly depending on the cause.

Aphonia is different from aphasia, which is a language disorder.

Causes

Aphonia is usually due to problems with the voice box (called the larynx). However, there can be other causes, including:

• Conditions that affect the vocal cords or airway. This may involve injury, swelling, or disease, such as:
  • Laryngitis caused by a viral, bacterial, or fungal infection
  • Vocal abuse—yelling or talking excessively
  • Exposure to airborne irritants, such as smoke or air pollution
  • Acid reflux from gastroesophageal reflux disease (GERD)
  • Thickening of the vocal chords
  • Nodules or polyps on the vocal chords
  • Muscle tension dysphonia
  • Damage to the nerves that affect how the larynx functions
  • Laryngeal or thyroid cancer
  • Removal of larynx
  • Breathing problems that affect the ability to speak
  • Neurological disorders such as myasthenia gravis, multiple sclerosis, Parkinson’s disease, and amyotrophic lateral sclerosis
• Psychological conditions such as hysterical aphonia

Risk Factors

Factors that may increase your chance of developing aphonia include:

• Overusing your voice such as speaking until you are hoarse
• Behaviors that abuse your vocal chords, such as smoking, which also puts you at a higher risk for cancer of the larynx
• Having surgery on or around the larynx

Symptoms

Symptoms may include:

• Inability to speak or inability to speak above a whisper
• Hoarseness
• Spasm of vocal cords
• Throat pain
• Difficulty swallowing—food or fluids may go into the lungs

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

The cause of your symptoms may not be obvious. You may be referred to an ear, nose, and throat doctor. This doctor may use an instrument called a laryngoscope to examine your vocal cords. Other tests may also be done to evaluate your voice function.

If your doctor is concerned that there may be a neurological or psychological cause, you may be referred to other specialists.

Treatment

You can take the following steps to help ease laryngitis:

• Rest your voice.
• Avoid smoking.
• Stay hydrated.
• Use a cool mist humidifier.
• Take over-the-counter pain relievers, such as acetaminophen and ibuprofen.

Other treatments depend on the specific cause, such as:

• Participating in voice therapy if your loss of voice is due to voice overuse
• Taking medication to control acid reflux
• Having surgery to remove growths

Prevention

To help reduce your chance of aphonia:

• If you smoke, talk to your doctor about ways to quit.
• If you drink, limit your intake.
• Limit your exposure to fumes and toxins.
• Avoid talking a lot or yelling.
• Avoid whispering.
• Learn vocal techniques from a voice therapist if you have to speak a lot for your job.
• Get treatment for conditions that may cause loss of voice.

National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov

Speech-Language & Audiology Canada http://www.caslpa.ca

Casthely PA, Labagnara J. Hoarseness and vocal cord paralysis following coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 1992;6(2):263-264.

Fact sheet: common problems that can affect your voice. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
http://www.entnet.org/content/common-problems-can-affect-your-voice
Accessed August 21, 2014.

Hoarseness or loss of voice. The Harvard Medical School Family Health Guide website. Available at:
http://www.health.harvard.edu/family_health_guide/symptoms-hoarseness-or-loss-of-voice
Accessed August 21, 2014.

Maniecka-Aleksandrowicz B, Domeracka-Kolodziej A, et al. Management and therapy in functional aphonia. Otolaryngol Pol. 2006;60(2):191-197.

Sancho JJ. Pascual-Damieta M, et al. Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg. 2008;95(8):961-967.