James P. Dworkin-Valenti*, Nathan Vandjelovic and Samba S.R. Bathula
Abstract:
Objectives: To discuss the relationship between the physiologic and psychologic control of laryngeal function.
Study design: Single subject retrospective research investigation.
Methods: Here we present the case history of a highly intelligent, normally developing teenager from a middle-class family background who suffered idiopathic recurrent bouts of mutism, which were originally and erroneously diagnosed as manifestations of a paradoxical vocal fold movement disorder. The patient was refractory to standard respiratory retraining and voice therapy exercises. Based on our previous experiences and research with other patients, we employed trans-cricothyroid Lidocaine and saline injections on separate occasions to restore functional voice control.
Discussion: The physiology of normal voice production depends upon discreet integration of complex cortical, auditory, sensori-motor, and end organ activities. There is a subset of patients with non-organic dysphonia who exhibit respiratory and laryngeal muscle hypertension as a consequence of underlying psychological disequilibrium. Voice difficulties in this clinical population may range from intermittent harsh vocal quality to protracted aphonia. Lidocaine injection after the first and second occurrence of mutism and saline injection after the third manifestation had immediate and demonstrably positive results following each treatment session. Alternative physiogenic versus psychogenic explanations for these outcomes are presented.
Conclusion: There is a complex and poorly understood relationship between the physiologic and psychologic factors leading to conversion reaction mutism. We found that disruption of a potentially dysfunctional sensori-motor feedback loop, via trans-cricothyroid injections, quickly resulted in return of normal voice.
Objectives: To discuss the relationship between the physiologic and psychologic control of laryngeal function.
Study design: Single subject retrospective research investigation.
Methods: Here we present the case history of a highly intelligent, normally developing teenager from a middle-class family background who suffered idiopathic recurrent bouts of mutism, which were originally and erroneously diagnosed as manifestations of a paradoxical vocal fold movement disorder. The patient was refractory to standard respiratory retraining and voice therapy exercises. Based on our previous experiences and research with other patients, we employed trans-cricothyroid Lidocaine and saline injections on separate occasions to restore functional voice control.
Discussion: The physiology of normal voice production depends upon discreet integration of complex cortical, auditory, sensori-motor, and end organ activities. There is a subset of patients with non-organic dysphonia who exhibit respiratory and laryngeal muscle hypertension as a consequence of underlying psychological disequilibrium. Voice difficulties in this clinical population may range from intermittent harsh vocal quality to protracted aphonia. Lidocaine injection after the first and second occurrence of mutism and saline injection after the third manifestation had immediate and demonstrably positive results following each treatment session. Alternative physiogenic versus psychogenic explanations for these outcomes are presented.
Conclusion: There is a complex and poorly understood relationship between the physiologic and psychologic factors leading to conversion reaction mutism. We found that disruption of a potentially dysfunctional sensori-motor feedback loop, via trans-cricothyroid injections, quickly resulted in return of normal voice.
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