Similarities of signs and symptoms of functional psychogenic dysphonias and of dysphonias with suspect simulation: differential diagnosis

Abstract

Purpose: To verify which are the vocal behaviors and anamneses data that are characteristic of patients that have dysphonia with sign of simulation suspect comparing them to patients with functional psychogenic dysphonia. Methods: Joined the research ten patients, nine female and one male with vocal alteration complaints. Six of them have an otorhinolaryngologic diagnosis of functional psychogenic dysphonia and the others have an indefinite diagnosis with sign of simulation. All patients were vocally evaluated, answered the differential diagnosis protocol and were sent to an otorhinolaryngologic and a psychiatric evaluation. Results: The six patients with functional psychogenic dysphonia are female. Of the four others with indefinite diagnosis with simulation suspect, three are female and one is male. In the indefinite cases, three of them have laryngeal alterations. Other data presented here include a gradual beginning of dysphonia, anxiety, excessive sweating or nervousness during the evaluation and request for a technical inspection. Laryngeal alterations were not observed on five patients with functional psychogenic dysphonia. Other differential aspects include a rough beginning of dysphonia, lack of anxiety, excessive sweating or nervousness during the evaluation. Incongruent symptoms and excessive flutuation were found on both groups of dysphonia. Conclusion: The differential diagnostic between functional psychogenic dysphonia and the dysphonia with signs of simulation is subtle due to the symptoms and signs similarity. In the evaluation of a dysphonia with sign of simulation a clinical observation is necessary, especially due to symptoms incongruity.