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Aphonia after closed head injury: aetiologic considerations.

This report describes two patients with closed head injuries and post-traumatic aphonia who regained their voices within one session of symptomatic voice therapy. Their abilities to cough and swallow were intact, and articulation was only mildly impaired. One patient had an ataxic dysarthria and the other had spastic (pseudobulbar) dysarthria. Neither patient had oral-verbal apraxia. The findings argue against laryngeal paralysis or apraxia of phonation as the underlying cause of the aphonia. Neuropsychologic assessment revealed mild generalised intellectual impairment and frontal lobe signs but no aphasia. We postulate that the aphonia may have been due to a frontal lobe-limbic system disturbance, which affected these patients’ motivation, personality, and judgment. Diagnostic and therapeutic aspects of post-traumatic aphonia are discussed.