The doctor explained the causes of voice problems during prolonged stress

Psychoemotional stress can provoke changes in vocal function by affecting the muscle tone of the larynx. On August 9, Galina Chudinskaya, a neurologist at Medicine JSC (Academician Roitberg Clinic), told Izvestia about this.

"The voice is a complex physiological mechanism involving the central nervous system, respiratory muscles, larynx, and articulatory apparatus. One of the key factors that can disrupt the normal functioning of the vocal apparatus is psychoemotional stress, in particular anxiety and chronic stress," the doctor explained.

Anxiety and stress can actually lead to voice changes. According to Chudinskaya, numerous clinical and scientific studies confirm that psychoemotional factors play an important role in the development of vocal disorders. This is especially true in so-called functional dysphonia, when there is a significant change in voice in the absence of organic lesions of the larynx (for example, polyps, paresis, tumors).

"The mechanism of the influence of anxiety and stress on the voice is associated with neurophysiological and autonomic reactions. The sympathetic nervous system is activated: under stress, the level of cortisol and adrenaline increases, which leads to a general tension of the skeletal muscles, including the muscles of the larynx (in particular, the arachnoid laryngeal, thyroid, and others)," the neurologist clarified.

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In addition, increased muscle tone (hypertonia) is also affected: the muscles of the larynx become excessively tense, which disrupts the normal vibration of the vocal folds. This can lead to insufficient or excessive closing of the vocal folds, which is manifested by hoarseness, strained voice or fatigue.

Discoordination of breathing and phonation: stress disrupts the rhythm of breathing (shallow, rapid breathing), which leads to a lack of sub—vocal pressure - the basis for normal voice formation. This is especially noticeable among people whose profession is related to speech (teachers, singers, lecturers).

"The role of the limbic system and the cerebral cortex is also important: anxiety activates the amygdala and other structures of the limbic system, which, through the reticular formation and cortical-nuclear pathways, can directly affect the motor neurons of the cranial nerves (in particular, the vagus nerve — X pair) innervating the larynx," the specialist warned.

The diagnosis of the psychogenic component of a vocal disorder, the doctor noted, requires an interdisciplinary approach — the participation of a speech therapist, an otolaryngologist, a neurologist and a psychotherapist. The main signs indicating a connection with anxiety and stress are the onset of symptoms against a background of psychoemotional stress (conflict, exam, public speaking), fluctuation of symptoms: the voice may be normal in a relaxed environment and disappear in stressful situations, the absence of organic pathology during laryngoscopy (normal structure and mobility of the vocal folds).

It may also be concomitant somatic manifestations of anxiety: sweating, palpitations, trembling, a feeling of lack of air; a feeling of "lump in the throat" (globus pharyngeus) - a common symptom of anxiety disorders; tension of the neck and shoulder girdle muscles detected by palpation; a positive response to psychotherapy or medication for anxiety with simultaneous improvement in voice.

Chudinskaya explained that videostrobolaryngoscopy is used to confirm the diagnosis — to assess the vibration of the vocal folds; electromyography of the larynx (in difficult cases) — to detect pathological muscle tension; psychological testing (anxiety scales, depression — HADS, STAI, etc.).

"Ignoring the psychoemotional cause of a vocal disorder can lead to the chronicling of the process and the development of serious complications. For example, the formation of chronic functional dysphonia: a stable pathological pattern of voice formation develops from temporary stress," the doctor warned.

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In addition, primary muscular tension of the vocal folds (PMTV) may occur — a condition in which constant tension of the laryngeal muscles leads to pain, fatigue and persistent vocal impairment, the development of secondary organic changes: prolonged excessive tension can cause hypertrophy of the laryngeal muscles, tension furrows, swelling of the vocal folds (type "vocal nodule stress").

"Anxiety and stress are not just "psychological" states, they have a real and measurable impact on the physiology of the vocal apparatus. Changing the voice in response to stress is not an invention of the patient, but an objective manifestation of neuromuscular dysfunction caused by the activation of stress systems of the body. It is important to understand that the treatment of such vocal disorders requires a comprehensive approach," the specialist noted.

Thus, it is necessary to correct anxiety disorders (psychotherapy, if necessary, drug therapy), work with a speech therapist (vocal gymnastics, relaxation of the laryngeal muscles), training in stress management techniques (breathing practices, MBT, meditation).

Early diagnosis and the inclusion of psychotherapeutic methods make it possible not only to restore the voice, but also to prevent the chronization of the disorder, preserving the patient's quality of life, the neurologist concluded.

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