Functional voice disorders: Clinical presentations and differential diagnosis

Area of Science:

• Otolaryngology and Speech-Language Pathology
• Neuroscience and Psychology

Background:

• Functional voice disorders encompass heterogeneous conditions, notably psychogenic voice disorder (PVD) and muscle tension voice disorder (MTVD).
• Psychosocial factors are empirically linked to the onset and persistence of these voice disorders.
• Understanding the distinctions and overlaps between PVD and MTVD is crucial for accurate diagnosis and effective treatment.

Purpose of the Study:

• To provide an overview of functional voice disorders, specifically PVD and MTVD.
• To examine the role of psychosocial factors in the etiology and maintenance of these conditions.
• To differentiate PVD and MTVD from neurologically based voice disorders through clinical features and assessment.

Main Methods:

• Review of existing literature on prevalence, demographics, and psychosocial associations of functional voice disorders.
• Description of clinical features distinguishing PVD and MTVD presentations.
• Discussion of assessment procedures and auditory-perceptual voice characteristics for differential diagnosis.

Main Results:

• PVD shares characteristics with psychogenic movement disorders and other functional neurologic disorders, suggesting a potential classification.
• Key differences between PVD and MTVD aid in distinguishing their clinical presentations.
• Assessment methods and voice analysis can help differentiate functional from neurological voice disorders, though ambiguity may exist.

Conclusions:

• Clinical management of PVD and MTVD benefits from integrating behavioral voice therapy with 'top-down' counseling or psychotherapy.
• The findings support the conceptualization of PVD as a subtype of functional neurologic disorders.
• Speech-language pathologists play a key role in the differential diagnosis and integrated treatment of these voice conditions.