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In clinical practice it may be difficult to evaluate the cause of acute dysphonia and aphonia. With the aim of elucidating the aetiology, diagnosis and management of patients with acute voice disorder, we have studied different populations with acute laryngitis and psychogenic voice disorder (PVD). The results indicate that bacterial infection is common only in patients with acute laryngitis (65%) whereas asthma-like symptoms are reported in a high proportion of patients with PVD (37%). The two populations are rather similar with regard to age, gender, smoking habits, perceptual features of dysphonia and occurrence of concomitant minor laryngeal abnormalities. Neurogenic disorders may sometimes give rise to peculiar vocal symptoms with rapid onset, here illustrated by two clinical cases: bilateral recurrent nerve palsy with acute onset of aphonia, and mutism due to sclerosis multiplex of the brain.

The starting point of this study was that two of the authors independently experienced vocal fatigue when singing after they had played their wind instruments. We studied six subjects who played fl...