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Die Atiopathogenese funktioneller Dysphonien ist komplex; es reicht nicht aus, nur auf vokale Verhaltensaspekte zu schauen. Die dispositionelle Basis fur eine funktionelle Dysphonie kann konstitutionell, Sprechberufs-, Sprechverhaltens- und/oder personlichkeitsbedingt sein. Ausloser konnen (chronischer) Stress, stimmliche Uberbeanspruchung, ungunstige Sprechgewohnheiten, Infekte der oberen Luftwege, entzundliche Prozesse im Kehlkopf, belastende Lebensereignisse und COSO events sein. Die Interaktion von pradisponierenden und kausalen Faktoren ist unbekannt. Stress, Erschopfung, Angst, Depressivitat und/oder Personlichkeitsmerkmale, die Krankheitsbewaltigung (Coping) erschweren oder verhindern, gelten als aufrechterhaltende Faktoren. Stets ist eine Uberlagerung der Stimmsymptomatik durch reaktive psychische und soziale Auffalligkeiten zu berucksichtigen (z. B. Leidensdruck, depressive Verarbeitung, Sprechangst, sozialer Ruckzug). Da die Assoziation multipler psychosozialer Faktoren mit funktionellen Dysphonien nicht trennscharf ist – eine solche ist stets bei organmedizinisch nicht begrundbaren Symptomen anzutreffen – sind funktionelle Dysphonien psychodiagnostisch zu differenzieren. In Anlehnung an den ICD-10 Kpt V (F00-F99) wird ein diagnostischer Pfad vorgestellt. Unbekannt ist bislang, welche psychosozialen Faktoren eine psychogene Dysphonie von einer „Muscle Tension Dysphonia“ unterscheiden.

STROBOSCOPY FINDINGS: A COMPARISON OF FLEXIBLE CCD-VIDEOSTROBOSCOPY AND RIGID STROBOSCOPYOBJECTIVE: After exclusion of morphologic laryngeal alterations by laryngoscopy the prospective study compared stroboscopy findings using a flexible distal charge-coupled device chip-optic (CCD-optic) and a rigid 70°- or 90°-laryngoscope. MATERIAL AND METHODS: 52 patients with functional dysphonia and 47 candidates for speech therapy education were checked with both examination methods. The stroboscopy results were rated randomized and pseudonymized by 3 experts assessed by a study protocol according to the European laryngological society basic protocol 2001. RESULTS: The interrater-reliability was moderate to good. Using the flexible videolaryngoscopy less gaging, less supraglottic contraction during phonation, more often a complete glottal closure and more often a normal mucosal wave movement were found. CONCLUSION: To get an optimal endoscopy result the combination of rigid laryngoscopy and flexible videolaryngoscopy and -stroboscopy will be recommended. Because of the variety of stroboscopic findings for the diagnosis of functional dysphonia additional the case history and functional voice examinations are necessary.

After a head or a cervical injury dysphonia and its accompanying globus syndrome are often ignored, even if the existence of these traumatic sequelae are repeatedly reported. Till now there is no coherent idea about their pathogenesis, wherefore in the individual case wide differences exist in the diagnosis, treatment and in the expert opinion. It could be shown in this paper, that a posttraumatic dysphonia, due to a minor trauma, is a well defined disease with an uniform pathogenesis. The diagnosis results from the typical anamnesis of the accident, from the prove of the functional dysphonia and last not least from the prove of a functional deficit of the cervical spine, especially in the height of C 2/3. The right diagnosis allows a causal treatment and enables a just expert opinion.

A total of 160 voice-trained and untrained subjects with functional dysphonia were given a "clinical rating" according to their clinical findings. This was a certain value on a scale that recorded the degree of functional voice disorder ranging from a marked hypofunction to an extreme hyperfunction. The phonetograms of these patients were approximated by ellipses, whereby the definition and quantitative recording of several phonetogram parameters were rendered possible. By means of a linear combination of phonetogram parameters, a "calculated assessment" was obtained for each patient that was expected to tally with the "clinical rating". This paper demonstrates that a graduation of the dysphonic clinical picture with regard to the presence of hypofunctional or hyperfunctional components is possible via computerised phonetogram evaluation. In this case, the "calculated assessments" for both male and female singers and non-singers must be computed using different linear combinations. The method can be introduced as a supplementary diagnostic procedure in the diagnosis of functional dysphonia.