When all voice is gone – the silent reality of aphonia

There are times, in some people’s lives when all voice will be gone.  For most of us, it will be a short-lived experience, probably due to a throat infection or virus which causes laryngitis.  With laryngitis, the vocal folds become progressively inflamed and swollen until finally they temporarily loose their ability to vibrate adequately enough to produce voice.   The good news is, laryngitis is temporary. The more you rest off the flu / infection / virus and avoid pushing your voice for a few days, the quicker your voice will return.  Rest your voice and your body if you can – good sleep helps. If you continually attempt to push a voice out, this will usually only produce an even harsher whisper and could set up a pattern of throat discomfort and voice muscle strain for the future.

If you require help after a period of laryngitis or experience voice change following a cold, flu or illness such as covid-19 infection, specialist voice therapy can help rehabilitate your larynx and voice back to optimal functioning.

The transient loss of voice associated with laryngitis due to virus or infection provides a taster of the reality of total absence of voice known as aphonia. Direct social interaction becomes challenging to say the least.  Emailing and texting help in less direct interventions but what about when the phone rings? Or you need to speak to a shop assistant, receptionist, waiter, bus driver etc?  Going out for a coffee, lunch, dinner etc with friends and family becomes a difficult experience.  Speaking in work meetings is no longer a given. Its not long before frustration can set in.  

The emotional toll of voice loss can be very significant.  It can be a frightening place to find oneself in.  In many cases, by the time the individual accesses voice therapy, anxiety has built up consistently.  Even for low or moderate level voice users, voice loss is a challenge.   The effect on the more talkative and social people is usually heightened anxiety; for professional voice users, performers and singers, the stress and loss of income can be hard to manage. 

In many cases of aphonia, the vocal cords are not damaged or physically impaired.   However, the voice loss typically follows a period of sickness. Although the vocal cords look normal after the sickness has passed, the voice doesn’t return as before or at all. This can also happen after voice surgery e.g. to remove a polyp.  Typically, the vocal cords appear normal at the post surgery ENT (Ear, Nose & Throat) check-up but the voice is absent.   (For more information about accessing an assessment of your larynx and vocal cords with an ENT, please see the information below).

One of the most anxiety inducing aspects of total voice loss is the feeling of isolation.  One of the questions I’m most often asked is: “have you ever seen this happen to anyone else?”  Voice loss can be panic inducing for the individual.    Rest assured that experienced voice specialist SLTs will be familiar with working with aphonia. With the right support and treatment, voice restoration to the full level possible for each respective individual is a very achievable outcome. For some, voice rehabilitation can be quick – within two sessions. For others, more sessions will be required.  The clinician will be able to guide you further about this at your first appointment.

Assessment by an Ear, Nose and Throat doctor is important whenever a  person has experienced voice change or loss for two weeks.    In the NHS, G.Ps can refer their patients to ENT service/ department. (Most larger hospitals have an ENT department).  A delay in accessing G.Ps and ENTs is common nowadays, but do persevere if your voice remains troublesome.  For individuals who have private health insurance, accessing an ENT assessment is generally straightforward (your insurance company may ask you to seek a GP referral first).  If you don’t have private health insurance but can self-fund, individuals can seek out a private ENT assessment without a G.P referral.