Complaints of patients with functional dysorders of voice production accompained by hypotonic condition of the vocal apparatus
Authors: Shidlovskaya Tetiana A. , Volkova Tetyana V. 
Published: January 2021

Topicality: Hypotonic functional dysphonia, especially a chronic disease (CHFD), is the most common nosology among all functional voice disorders. It is often accompanied by various complications and characterized by a very severe disease course, deteriorating significantly the voice function and general state of health of patients.
Materials and Methods: A total of 123 patients with chronic hypotonic functional dysphonia were examined and divided into 4 groups depending on the violation degree in the vocal apparatus. The 1st group included 25 patients with mild disorders in the vocal apparatus, the 2nd group included 33 patients having more severe laryngeal mobility disorders, the 3rd group comprised 34 patients with a complicated disease course (prenodulus state, vocal cords nodules, Mediale Edge thinning), and the 4th group was consisted of 31 patients having such complications as vocal cords nodules, prenodulus state and the larynx vestibular hypertonicity of various degree.
Results and Discussion: The complaints of severe hoarseness were reported in 44.0% of cases in Group 1, in 48.5% of cases of Group 2, in 64.7% of cases in Group 3, whereas in Group 4 the severe hoarseness was present in 77.4% of cases. Periodic voice loss was found in 32.0% of Group 1patients, among 42.4% of the patients from Group 2, among 52.9% of the patients from Group 3, and in 67.7% of cases it was reported in Group 4. In the first group, 56.0% of the patients described their complaints in various ways including unpleasant sensations in the larynx, irritation, dryness and a “ball” in the throat, 60.6% of the patients from the second group complained of the same symptoms, 70.6% of the patients from the third one, as well as 74.2% from the fourth group, respectively.
Recurrent pain in the larynx, mainly caused by voice loading, was found in 24.0% of Group 1patients, in 30.3% of Group 2 patients, in 41.2% of Group 3 patients and 51.6%of the patients from Group 4. Thus, the severity of these symptoms was increasing simultaneously with deteriorating the vocal apparatus.
The 72.0% of Group 1patients, 60.6% of Group 2 patients, 70.6% of Group 3 patients, and 90.3% of Group 4 patients complained of voice fatigue. In the first group, 40.0% of patients complained of intermittent coughing due to voice loading or to the desire “to talk” in the morning, as well as 39.4% of patients from the second group reported the same symptoms, and 44.1% of patients from the third group and 54, 8% from the fourth one, respectively.
The neck muscle tension during phonation was experienced by 16% of patients from the first group, 36.4%- from the second group, 52.9%- from the third group and 70.9% of the patients from the fourth one. Therefore, the patients with the larynx vestibular hypertonicity reported they had the most severe sensations.
Regarding the complaints of general state of health, the patients of Group 1 complained mostly of headache (52.0%), heaviness in the head (44.0%), irritability and high emotionality (56%). The patients of Group 2 had the most complaints of headache (57.6%), sleep disorders (48.5%), irritability and high emotionality (57.6%). The patients of Group 3 suffered from headache in 67.6% of the cases, from heaviness in the head in 58.8% of the cases, from sleep disorders in 58.8% of the cases, irritability and high emotionality in 70.6% of the cases. And the vast majority of patients from Group 4 complained of headache (77.4%), heaviness in the head (67.7%), sleep disorders (74.2%), irritability and high emotionality (87.1%), meteorological dependence (67.7%). So, the complaints of general state of health, especially with regard to headache, sleep disorders, irritability, high emotionality and meteorological dependence were mostly reported in the patients with HFD having a complicated disease course (Groups 3 and 4). This suggests that the central nervous and cardiovascular systems condition should be taken into account
when treating patients with complicated HFD and severe voice disorders.
Thus, the data on the examined groups of patients with CHFD show a tendency to an increase in the number of patients’ local health complaints and, especially, general health complaints starting from the first to the fourth group. The patients’ local health complaints include those of severe hoarseness, neck muscle tension, laryngeal pain during phonation and viscous sputum in the vocal cords, and periodic voice loss. Regarding to general health complaints, such as headache, sleep disorders, irritability and meteorological dependence; we can also observe the dynamics of growth in health complaints from the first to the fourth group. The obtained data will contribute to improving the quality of diagnosis in case of functional voice disorders, and can also be used in solving issues related to professional suitability of people of voice profession and medical-labour expert commission.
Conclusions:
1. The patients with CHFD in all study groups mostly had such common local health complaints as severe hoarseness, voice fatigue and discomfort (irritation, dryness, viscous sputum, muscle tension) of the vocal apparatus, and also, headache, sleep disorders and irritability as the general state of health is concerned.
2. The frequency and severity of almost all studied health complaints, both general and local, increased from Group 1 (mild CHFD) to Group 4 (complicated severe CHFD) of patients with voice disorders, but, especially, in regard of such local health complaints as severe hoarseness, voice fatigue, neck muscle tension during phonation, sensation of irritation and laryngeal pain and such general health complaints as headache, sleep disorders, meteorological dependence and irritability.
3. The significant number of complaints increases (headache, heaviness in the head, irritability, sleep disorders, meteorological dependence and others) simultaneously with the deterioration of the vocal apparatus, which may indicate a violation of the central nervous system and cerebral circulation in patients with severe disorders of the voice function.