Hyperfunctional dysphonia

HFD Basics

Acronyms Medical

According to abbreviationfinder, HFD stands for Hyperfunctional dysphonia. Hyperfunctional dysphonia is a voice disorder without an organic cause. Patients habitually overstrain the muscles involved in voice production. During logopedic therapy, they learn to normalize their voice formation in a targeted manner.

What is hyperfunctional dysphonia?

Patients with hyperfunctional dysphonia suffer from a number of different symptoms that can be more or less pronounced. In most cases, their voice sounds rough, hoarse and diplophonic.

The articulation has a vocal part to some degree. This vocal part of articulation is impaired in dysphonia. Depending on the findings and the severity, the voice in hyperfunctional dysphonia sounds hoarse to rough, breathy or occupied.

A patient with dysphonia can only vary the timbre of the voice, the pitch of the articulation and the volume of the articulated sounds to a limited extent. Patients with dysphonia often complain of dryness and a foreign body sensation in the throat. The result is compulsive clearing of the throat. There are several subgroups of dysphonia. One of them is hyperfunctional dysphonia.

This speech disorder is caused by a regular, unintentional and excessive contraction of the voice-forming muscles. In addition to the phonation musculature, the respiratory musculature and the articulation musculature as well as the throat musculature are involved in voice formation. Hyperfunctional dysphonia is a voice disorder that results from overuse of these muscles.


Dysphonias have either organic or functional causes. The organic causes include inflammation, symptoms of paralysis, neoplasms and reflux of gastric acid. Laryngeal injuries or malformations of the larynx are only rarely the cause.

Functional dysphonia, on the other hand, is caused by overload, for example, in speech habits that damage the voice. Such dysphonia is also referred to as habitual dysphonia. Since the cause of hyperfunctional dysphonia corresponds to an overload of the muscles involved in the articulation, this type of dysphonia is often a habitual functional dysphonia.

The designation as “hyperfunctional” provides information on the cause as well as information on the effect. In hyperfunctional dysphonia, the overloading of the muscles leads to an excessive use of force in the articulation and in this way changes the sound of the articulated sounds. In addition to the causes mentioned, factors such as alcohol consumption and nicotine consumption can contribute to hyperfunctional dysphonia or exacerbate existing dysphonia.

Symptoms, Ailments & Signs

Patients with hyperfunctional dysphonia suffer from a number of different symptoms that can be more or less pronounced. In most cases, their voice sounds rough, hoarse and diplophonic. Many of those affected produce several frequencies at the same time and experience their voice disorder in addition to being accompanied by a compulsion to clear their throat and swallow.

When swallowing empty, they are plagued by a feeling of a lump. Your hoarseness increases depending on the strain on your voice. Occasionally there is pain in the larynx area. There is a foreign body sensation in her throat, often described as mucus in her throat.

Some of the patients feel shame or at least uncomfortable feelings about their own vocalization. In some cases, those affected try to speak as little as possible from now on. In exceptional cases, the lack of flexibility of the voice leads to misunderstandings in the social sphere.

For example, intonation and its possible variations play a key role in social language acts such as irony or sarcasm. Hyperfunctional dysphonia can thus make it difficult to convey specific interpretations of what is articulated.

Diagnosis & course of disease

In the case of hyperfunctional dysphonia, backward-sloping epiglottis and reddened vocal folds are diagnostic criteria. Another criterion are protruding pocket folds and a dorsal terminal insufficiency. A long final phase and the low amplitudes of vocal fold vibrations can also be relevant for the diagnosis.

The doctor makes the diagnosis with a voice test and combines this test with visual diagnostic assessment of the structures involved in articulation. The prognosis for people with a hyperfunctional voice disorder is good. In comparison, organic voice disorders have a significantly less favorable prognosis and often leave behind permanent voice changes. In contrast, hypo- and hyperfunctional dysphonia can be completely cured.


One of the most common forms of voice disorders is hyperfunctional dysphonia, which usually occurs as a result of inefficient use of the voice or after a cold. The patient uses too much pressure in the production of voice, exerts excessive effort on the muscles and, over time, overloads them.

There are promising therapies that are guided by voice therapists and speech therapists. However, complications are possible. Over time, a hyperfunctional voice disorder caused by improper use can develop into an organic voice disorder. One of the most common changes are the nodules on the vocal folds, also known as screaming nodules. Small thickenings form on the vocal folds, which can still be treated in the early stages with vocal exercises.

The longer they exist and the more solid they are, the more likely it is that surgery will be followed by voice rest and therapy. Furthermore, hyperfunctionally stressed vocal folds are susceptible to infections and quickly become inflamed. Recurring hoarseness and lack of voice are the consequences. The swollen vocal cords sometimes cause shortness of breath.

With extremely overloaded voices it is possible that the so-called pocket fold voice develops. The pocket folds lie directly above the actual vocal cords. When they fill in for the normal voice, the voice sounds tight, harsh, hoarse, and very deep. Psychological complications are also to be expected. It is not uncommon for patients to depend on a good voice for their job. If it fails again and again, fears about the future are the result.

When should you go to the doctor?

Changes in vocalization indicate diseases that often require treatment. If the abnormalities persist for a long time or if they increase in intensity, a doctor must be consulted. Hoarseness that persists without an apparent cause should be evaluated and treated.

Constant clearing of the throat, difficulty swallowing or a dry mouth are signs that should be investigated. A doctor should be consulted if there is a foreign body sensation in the throat, discomfort in the throat area or changes in the mucous membranes in the throat. If there is pain, a feeling of tightness or loss of appetite, it is advisable to clarify the symptoms.

Pain medication should only be taken in consultation with a doctor. If food is refused and there is severe weight loss, the person concerned needs help. There is a risk of an undersupply of the organism. Sleep disturbances, nervousness or a general feeling of being unwell should be checked out if they last for several weeks.

If those affected suddenly refuse to speak or severely restrict their articulation, a follow-up visit should be initiated. If the voice changes lead to behavioral problems, a withdrawal from the social environment or a depressive mood, a doctor’s visit is necessary. In the case of feelings of shame, fear or melancholic behavior, it is advisable to consult a doctor or therapist.

Treatment & Therapy

All functional voice disorders require awareness and, above all, training. The awareness of the act of articulation and self-monitoring during articulation form the basis for being able to work on vocalization during training. All functional dysphonias are treated as part of targeted voice therapy.

The therapy involves phoniatrists, breathing teachers, speech teachers and voice teachers or even speech therapists. This interdisciplinary team of experts teaches the patient disciplines such as vocalization adapted to the breathing rhythm. The patient is educated about the physiology of vocalization so that he can consciously monitor himself during the act of articulation.

Being aware of the causes of their voice disorder helps those affected to pay particular attention to the volume of their own voice while speaking. Because habitual hyperfunctional dysphonia is a habitual voice disorder, therapy can take a long time. Habits can only be changed with consistent and regular targeted training over a more or less long period of time.

Little by little, the patient gets used to speaking in a normal loud voice again. He learns to use less of his breathing, phonation, throat and articulation muscles. Unlike organic voice disorders, no invasive treatments are used for functional and hyperfunctional voice disorders.

The patient is thus spared any surgical procedures. During the period of therapy, those affected are usually advised to abstain from nicotine and alcohol.

Outlook & Forecast

The prognosis of hyperfunctional dysphonia is described as favorable. Since there is no organic cause of the voice disorder, permanent healing of the symptoms is possible. In many cases, a good and successful therapy is required so that the causes can be worked out and changed. The course of treatment can last from weeks to several years. The underlying cause and the willingness of the patient to cooperate in therapy are decisive.

Spontaneous healing is possible at any time. Likewise, the symptoms can regress if the treatment plan is not followed and the triggering overload is experienced again. In order to be permanently free of symptoms, the patient must learn to adapt his or her voice to the needs and possibilities of the organism.

Helpful tips on how to use the voice, tips on how to change one’s lifestyle and sufficient explanations of how vocalization works are intended to raise awareness among those affected. In the long term, this leads to sustained recovery and a favorable prognosis.

In addition, early warning signals are learned so that the patient can initiate changes and optimizations as quickly as possible if the symptoms return. The later therapy takes place, the more difficult it becomes to relearn how to speak. Nevertheless, even in these cases, a cure is possible.


Hyperfunctional dysphonia can be prevented. In addition to abstinence from nicotine and alcohol, dealing with the act of articulation can be understood as a preventive measure. Those who are aware of the physiological act of vocalization are less inclined to overstress the involved muscles.


Aftercare for hyperfunctional dysphonia initially focuses on adjusting the voice to the physical capabilities and needs. For those affected, this means that they have to rethink their lifestyle. The medical advice relates primarily to the use of your own voice and to explanations of the voice function.

The increased sensitivity of the patients helps to recognize possible warning signals early. Deterioration or changes can be recognized correspondingly quickly. If necessary, another visit to the doctor will help to adjust the therapy accordingly. Follow-up care often includes speech therapy.

This focuses on special exercises for the voice and also for the language. With regular training, those affected will soon be able to carry out these exercise units at home on their own responsibility. The voice training continues after the therapy sessions. Other sensible measures in connection with this direct aftercare are related to health awareness.

Disturbing influences such as smoking and alcohol should be avoided if possible. As a result, not only the physical condition improves, but also the psychological status quo. Social communication also plays a certain role here, because it ensures a better quality of life.

You can do that yourself

In order to improve his well-being despite hyperfunctional dysphonia, the patient uses his self-help measures to address both the physical and mental symptoms of the disease.

The usually unusual voice of those affected is conspicuous for outsiders and therefore often leads to feelings of shame in the patients. In the worst case, this results in social withdrawal and depression. In order to maintain or improve the quality of life, patients deal openly with hyperfunctional dysphonia and inform those around them that they suffer from the disease. The acceptance shown helps those affected to deal with hyperfunctional dysphonia and supports mental well-being.

With regard to the physical complaints, the patient usually receives logopedic therapy, during which he learns various exercises for training the voice and language. An essential factor for the success of logotherapy is the independent implementation of the training units at home, since the therapy hours alone are often not sufficient for a serious improvement. In addition, patients avoid smoking and alcohol if possible, which not only improves their physical and psychological well-being, but also has a positive effect on the course of hyperfunctional dysphonia.

Hyperfunctional dysphonia