The Girl With No Voice

10 year old Mary had not voiced for over 3 months. Not one vocalisation related to speech had ensued from her vocal tract in that time. She had already seen two ENTs and one speech therapist with no return of Voice. The second ENT, referred Mary to me. Both ENTs had assessed Mary’s laryngeal anatomy as normal with no evident pathology on the vocal cords. It seemed that Mary’s voice had never returned following flu and laryngitis symptoms. After 3 months, she had lost faith that her voice would ever return.

And so it was that in our first session, Mary told me how much soreness and discomfort she had been experiencing in her larynx. Her method of communicating was a strong whisper. This does not involve the vocal folds touching and vibrating as required to produce normal voice. Whispering requires the muscles around and above the larynx to be constricted so the air stream comes through a very small space. Whispering is not relaxing for the throat. Prolonged whispering tires and tightens the larynx. It is not recommended as a method of voice rest.

As for so much voice work, there was a logical lead to Marys symptoms – tightly held squeezed muscles over time led to an uncomfortable larynx.

Aphonia : the absence of voice

A myriad of possible causes can lead to aphonia – the absence of voice. This may include:

  • physical trauma or damage to the Larynx
  • Injury to the laryngeal nerve resulting in paralysis, or palsy partial paralysis, of the vocal fold(s).
  • Laryngitis if the vocal folds become so swollen they lose their ability to vibrate adequately.
  • Prolonged or excessive coughing
  • An unresolving muscle tension issue following periods of vocal strain / poor voice production technique.
  • Psychogenic reasons – when the body converts an emotional issue thats difficult to bear into the physical issue of voice loss.

A glimpse of voice is enough to determine vocal potential. 

I practised some exercises with Mary in her first session to assist the vocal folds to close. Occasionally, the exercises would elicit short glimpses of voice and a glimpse of voice is enough to determine vocal potential. It is not uncommon for individuals to unwittingly fall into a pattern of holding the vocal cords apart. It tends to happen subconsciously, as a reaction to temporary loss of voice such as laryngitis or following emotional stress or trauma.

I encouraged Mary to do short bursts of practice and not to stress too much. It was important not to add additional anxiety but to highlight that flickers of her voice had come through in the session which was good news.
Later that evening, Marys mother called to say she ‘couldn’t thank me enough’ . Marys full voice had returned and they were so surprised that it happened so quickly after the session but very happy.

Reconnecting a person to their voice brings great job satisfaction to the voice clinician; for the client and their family, the relief can be immense. I reviewed Mary one week later to assess her voice and positively reinforce her progress. Her voice had remained completely within normal limits. She was now a girl with full voice .