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A surgical procedure in which the larynx is removed because of such life-threatening diseases as cancer. By teaching people to maintain enough air pressure while speaking, and by systematically reinforcing progressively louder speech, clinicians can eliminate or minimize the problem. Loud speech that is considered appropriately loud in some societies may be considered offensively loud in other societies. However, some individuals speak too softly as a matter of habit and often are surprised that people have difficulty hearing them. However, a few disorders of loudness and pitch are independent of other problems. The typical client who seeks help for a loudness problem talks too softly. The loudness with which people speak varies across individuals and speaking situations. With the support of a sympathetic listener, the clients are expected to resolve their psychological conflicts. Aphonia that persists even after the disease has been treated or the injury has been healed is considered functional. A physical injury to the larynx or an extreme form of throat infection temporarily may keep the person from phonating normally. Organic aphonia is caused by impaired, injured, or absent laryngeal structures. On the other hand, the behavioral therapists do not believe that unconscious forces cause behavioral disorders of any kind, including functional aphonia. Most functionally aphonic people can produce voice at times. Therefore, the behavioral therapists tend to treat such disorders as aphonia by modifying the faulty behaviors. Once the underlying psychological problems are resolved, the voice problem is expected to disappear. Organically based aphonia may be a temporary phenomenon associated with certain physical diseases. Most cases of inadequate loudness can be treated easily. Individuals in some societies speak more softly than those in other societies do. They believe that most behavioral disorders are due to faulty learning and conditioning. It is generally thought that psychological problems underlie faint voice when it exists as an independent disorder. Frequently, the problems of loudness and pitch are part of other voice disorders. This form of treatment requires an analysis of the conditions under which the aphonic behaviors is typically present and the reinforcing consequences that maintain aphonia. Very few people seek professional help for loud speech unless it is a part of a larger problem, such as excessively loud talk that results in vocal nodules or polyps, which in turn create a voice problem. Obviously, the people who have such a surgery retain no natural or typical mechanism to produce voice. Whenever the client produces the vocal sound, the clinician may systematically reinforce this behavior and thus increase its duration and frequency. Permanent organic aphonia is associated with laryngectomy. The individual may recover voice when the organic problem has been treated. The breathy and hoarse voice is typically of low pitch. For example, clinically depressed talk too softly to be heard even under quiet conditions. Eventually, the aphonic behavior may be extinguished. Laryngeal pathologies may prevent a loud enough voice.
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