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This article describes the nature and treatment of functional voice disorders in adolescents. It summarizes physiological and psychological changes that occur in adolescence, the types of functional voice disorders common to that period, and the incidence and possible causes, including high-risk factors. Three case studies illustrate the importance of obtaining accurate laryngeal data, typical symptoms and signs, and the use of voice probes in diagnosis and treatment. The use of intensive treatment and carryover is stressed. The role of the school clinician in management is discussed, as is the need for screening programs and further research.

A psychogenic voice disorder co-occurred or evolved with the symptoms and signs of unilateral superior laryngeal nerve paresis. We speculated that the former was a manifestation of a musculoskeletal tension or conversion reaction disorder, whereas the latter was a sequela to a self-limiting inflammatory process. Voice therapy proved effective for alleviating the psychogenic dysphonia after the signs of the neuropathy had resolved, whereas psychotherapy offered strategies for stress management. A multidisciplinary approach to this patient provided for differential diagnosis and efficacious treatment.

The use of the s/z ratio as a clinical indicator of laryngeal pathology was investigated with 28 dysphonic subjects with laryngeal pathology (nodules or polyps), 36 dysphonic subjects without laryngeal pathology, and 86 normal-speaking subjects. While no statistical difference was found between the three groups in their ability to sustain /s/, the subjects with laryngeal pathology had significantly lower duration times for /z/ than subjects in the other two groups. The computed s/z ratios were significantly higher for the dysphonic subjects with laryngeal pathology; subjects with functional dysphonia free of laryngeal pathology demonstrated the same s/z ratios (approximately 1.0) as the normal-speaking control subjects. The dysphonic subjects with laryngeal pathology produced s/z ratios in excess of 1.4 ninety-five percent of the time. It appeared from these data that when an additive mass developed along the glottal margin, vocal fold approximation was less efficient. This decrement in efficiency appears to result in a decrease in glottal resistance, increasing air flow, and a shortened phonatory duration time. The clinical usefulness of the s/z ratio as a duration measure for identifying voice clients who may have laryngeal lesions is considered.