The role of the autonomic nervous system in the development of hypotonic dysphonia

Background. Hypotonic dysphonia occupies a special place in the structure of functional dysphonia in terms of prevalence. At the same time, the autonomic nervous system has a significant impact on the course and outcome of the disease. However, data on the neurovegetative status of patients with hypotonic dysphonia in the scientific literature are extremely rare and do not fully reflect its features.

Aim. To determine the neurovegetative status of laryngological patients with hypotonic dysphonia.

Materials and methods. 26 patients (6 men and 20 women) with hypotonic dysphonia and hypersensitivity of the larynx (main group) and 45 patients (13 men and 32 women) with hypersensitivity of the larynx without signs of dysphonia (comparison group) were examined as a control, data on the functional state of the autonomic nervous system in 20 practically healthy people (5 men and 15 women) aged 18 to 25 years were used. The state of vegetative parameters – vegetative tone, vegetative reactivity and vegetative activity support – were evaluated using the medical diagnostic complex “Valenta”. The examination of patients included anamnestic analysis, objective examination of lororgans according to generally accepted methods and video stroboscopy of the larynx.

Results. The differences between healthy and sick people regarding neurovegetative indicators are obvious, unidirectional and indicate the existence of autonomic disorders in both groups of patients. The ratios of vegetative parameters recorded during the study indicate the involvement of autonomic nervous system not only in the development of laryngeal hypersensitivity, but also in the pathogenesis of functional dysphonia of the hypotonic type.

Conclusion. Thus, neurovegetative disorders – vegetative dystonia and autonomic dysfunction – are one of the factors of the pathogenesis of hypotonic dysphonia.

1. Vasilenko S. Voice. Phoniatric aspects. Moscow: Energoizdat, 2002. (In Russ.)

2. Dietrich M., Verdolini Abbott K., Gartner-Schmidt J., Rosen C. The frequency of perceived stress, anxiety, and depression in patients with common pathologies affecting voice. J Voice 2008;22(4):472–88. DOI: org/10.1016/j.jvoice.2006.08.007

3. Shilenkova V.V. Dysphonia and voice. Yaroslavl: Avers Plus, 2018. 256 p. (In Russ)

4. Gerasimova I.Yu. Application of vegetocorrector in complex treatment of recurrent long-term voice disorders. Vestnik Otorinolaringologii = Bulletin of Otorhinolaryngology 2008;(5):311, 312. (In Russ.)

5. Gracheva M.S. Morphology and functional significance of the nervous apparatus of the larynx. Moscow: Medgiz, 1956. 163 р. (In Russ.)

6. Lowell S.Y., Barkmeier-Kraemer J.M., Hoit J.D. et al. Respiratory and laryngeal function during spontaneous speaking in teachers with voice disorders. J. Speech Lang Hear Res 2008;1(2):333–49. DOI: 10.1044/1092-4388(2008/025)

7. Sanders I., Wu B.L., Mu L. et al. The innervation of the human larynx. Arch. Otolaryngol Head Neck Surg 1993;119(9):934–9. DOI: 10.1001/archotol.1993.01880210022003

8. Hauser-Kronberger C., Hacker G.W., Albegger K. et al. Die Autonome und peptiderge Innervation des menschlichen Kehlkopfes. HNO 1994;42(2):89–98.

9. Yurkov A.Yu., Shustova T.I., Pugovkin A.P. Characteristics of adrenergic innervation of somatic muscles. Morfologiya = Morphology 2004;125(1):33–6. (In Russ)

10. Demmink-Geertman L., Dejonckere P.H. Neurovegetative symptoms and complaints before and after voice therapy for nonorganic habitual dysphonia. J Voice 2008;22(3):315–25. DOI: 10.1016/j.jvoice.2006.10.011

11. Yurkov A.Yu., Shustova T.I., Stepanova Ju.E. Neurovegetative component of the pathogenesis of functional dysphonia by hypotonus type. Rossiskaya otorinilaringologiya = Russian Otorhinolaryngology 2007;(3):120–2. (In Russ.)

12. Yurkov A.Yu., Shustova T.I., Alekseeva N.S. et al. Vegetative innervation of the human vocal larynx. Nervno-myshechnye bolezni = Neuromuscular Diseases 2022;12(2):64–9. (In Russ.). DOI: 10.17650/2222-8721-2022-12-2-64-69

13. Golubev V.L. Vegetative disorders: Clinic, treatment, diagnosis. Moscow: LLC “Meditsinskoe informatsionnoe agentstvo”, 2010. 640 p. (In Russ.)

14. Gromakovskaya M.M. Neurohumoral mechanisms of regulation of muscular activity. Moscow: Nauka, 1965. 234 p. (In Russ.)

15. Breckenridge B.M., Burn J.H., Matschinsky F.M. Theophylline, epinephrine, and neostigmine facilitation of neuromuscular transmission. PNAS 1967;57;(6):1893–7. DOI: 10.1073/pnas.57.6.1893

16. Desjardins M., Apfelbach C., Rubino M., Verdolini Abbott K. Integrative review and framework of suggested mechanisms in primary muscle tension dysphonia. J Speech Lang Hear Res 2022;65(5):1867–3. DOI: 10.1044/2022_JSLHR-21-00575