Knowledge about psychogenic dysphonias among speech and language therapists and other health care workers

Psychogenic dysphonias are voice disorders stemming from psychological imbalances of the individual. They are classified as functional voice disorders because they occur despite normal organic state of the vocal apparatus i.e. absence of structural damage and/or neurological disorders. The data about the frequency of psychogenic voice disorders in Slovenia are not known. Due to their complex profile and not systematical therapeutic procedures, psychogenic dysphonias are little and poorly researched. This master's thesis explores how well this pathology is known among the occupations that meet these patients most likely and most often: these are health care professionals and speech language therapists. In addition it specifically detects the incidence and prevalence of the desease based on the experience of respondents who have ever come into contact with these patients. The research involved 43 Slovenian speech and language therapists and 22 other health professionals employed in different Slovenian regions and institutions. For the purpose, a two-part survey was carried out. The data were collected in autumn 2016. The results from the first part of the research show that the term "psychogenic dysphonia" is more familiar to speech language therapists than to other health care professionals. This can be attributed to a better knowledge of the disorder, resulting from the studies curriculum. Speech language therapists, in contrast to healthcare professionals, also know the profile of the phoniatrician better because they come in contact with this specialist during their studies. Due to this knowledge, speech language therapist would initially refer a hoarse pacient to a phoniatrician, while the other healthcare professionals would opt for the otorhinolaryngologist (ENT). As far as the inclusion of different profiles of experts in the treatment of people with psychogenic dysphonia is concerned, the respondents are fairly familiar with the three mainly involved specialists: the phoniatrician, a speech language therapist, and a psychologist. However they are less acquainted with clinical manifestations of the disorders, in fact the responses are highly variable with the tendency towards hoarseness. Slovenian speech language therapists think that even in our country psychogenic voice disorders are more common in women, as it is also reported in professional literature; this, on the other hand, is the belief of less than half of other healthcare workers. Only a minority of respondents know about different types of dysphonia - they are least aware of the transsexual voice problems. Both groups would have referred a hoarse patient without any structural lesion to the psychologist equally. As far as direct experience with psychogenic patients, it turned out that both groups have had few. The second part was designed only for those who have ever come into contact with psychogenic dysphonia. This criterion was met by only six participants, what confirms the rarity of the disorder even in our country and a small number of professionals who deal with it. Each respondent has met on average only 20 of these patients. Half of the respondents treated such patients more than three times a year, others less often. About half of the respondents reported to have patients with psychogenic dysphonia in therapy less than half a year, and they were mostly women between the age of 20 and 40. The patients were mostly aphonic, only two respondents had to treat patients with inadequate voice at the end of puberty, and only one respondent reported treating a patient with a transsexual change of the voice. Some patients simultaneously developed other pathologies, while half of the respondents did not notice additional disturbances. The most frequent causes of the psychogenic voice problems are stress at work, family conflicts and traumatic events. Factors that contribute to a positive outcome of the therapy are patient's motivation, cooperation between experts, simultaneity of psychotherapy and speech-language therapy, extension of the basic problems, as well as a combination of different approaches, such as breathing exercises, relaxation exercises, voice exercises and therapeutic support. None of the respondents treated the patient alone. Each has collaborated with other profiles, whether with an ENT, a phoniatrician, a psychologist or a psychiatrist. The therapy outcome of those who had dealt with patients with psychogenic dysphonia, independently of the type of the disease, has been successfull. This type of survey, which has not been carried out in the Slovenian area yet, has given an initial insight into the characteristics of the sample of patients with psychogenic dysphonia/aphonia in Slovenia. It has revealed the need for better awareness among professionals, students and laymen who might come into contact with patients who have developed any type of psychogenic dysphonia