Clinical Research Case Report

Abstract

Background: Functional dysphonia (FD) refers to a voice disturbance that occurs in the absence of structural or neurologic deficits. Psychogenic stress has been implicated the pathogenesis of this clinical entity but may not always be present. It is a rare form of dissociative disorder and this case was unusual in several aspects. This presentation focuses on diagnostic issues in first time occurrence of a functional symptom in a middle aged male and its management.

Case Outline: The patient was a 40-year-old male patient who presented with acute onset dysphonia. MRI, Direct laryngoscopy and other diagnostic procedures failed to find an organic cause. The patient was treated as a possible case functional dysphonia. Functional MRI was done to rule out disturbances in cortical speech comprehension and articulation. No psychogenic stressor other than being witness to an RTA was apparent in the interviews. The patient was slightly able to articulate during the first Lorazepam assisted interview but no new stressor was elicited. The patient was treated with a modified form of speech therapy performed under lorazepam assistance, where he was initially instructed to enunciate simple phonemes and gradually produce more complex ones. He recovered completely after about 10 such sessions.

Conclusion: We present the rare case of a person with late onset complete functional dysphonia. The case is interesting unique with regards to the age of presentation, the slow onset of symptoms, the resistance prolonged course with resistance to usual treatments. FMRI findings in such acase are described for the first time. The treatment adopted a new method of speech therapy with gradual recovery of the patient.