EpistemisVocal fatigue (Asthenophonia)
Specialty: Otolaryngology.
Why it occurs
- Persistent vocal abuse or misuse (dysfunctional vocal muscle strain)
- Glottic insufficiency due to age-related atrophy of the vocal cords (presbyphonia)
- Unilateral paralysis or paresis of the recurrent laryngeal nerve of idiopathic or postsurgical origin
- Incipient bilateral vocal nodules or polyps that prevent complete closure of the glottis
- Laryngopharyngeal reflux disease that inflames the posterior larynx and reduces the elasticity of the vocal folds
Initial workup
Indirect laryngoscopy and nasofibrolaryngoscopy with high-definition strobe light to evaluate the mucosal wave of the vocal folds, vibratory symmetry and the presence of glottic clefts (such as the sulcus vocalis or glottic gap), and acoustic analysis of the voice.
red flags
Persistent and invariable dysphonia lasting more than 3 weeks, mild inspiratory stridor during physical exertion, persistent cough with streaks of blood, progressive dysphagia, or appearance of an asymptomatic cervical lump.
Standard management
- Scheduled relative vocal rest and speech therapy myofunctional therapy directed by a specialist — fundamental pillar of treatment
- Proton pump inhibitors if there are strobe signs of reflux
- Corticosteroids in very short cycles if there is acute vocal cord edema due to overexertion, such as dexamethasone — 4 mg orally every 24 hours for 3 days
- Abundant systemic hydration with water.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 5
- Treatment options
- 4