A 16-year-old girl in Virginia developed a stutter after performing with her marching band at her first home football game. The stutter later gave way to a complete loss of her conversational voice. Yet she could still sing.
Doctors at Carilion Clinic and the Virginia Tech Carilion School of Medicine in Roanoke described the case in Psychopharmacology Bulletin in July 2025. They diagnosed a psychogenic speech and voice disorder, a condition in which psychological factors disrupt the voice without any structural problem.
What made the case stand out was the split between speaking and singing. According to the authors, no previous cases in the medical literature had examined loss of the conversational voice with preservation of the singing voice.
From a Stutter to Total Silence
The girl had no known psychiatric history, according to the full case report by Courtney Barth, Brianna Chang and Anuradha Reddy. Her parents first brought her to an emergency department after a one-day history of intermittent tremor in her hands and speech that sounded drawn out. It progressed to near-constant stuttering and dropped words.
Shortly before, she had a mild upper respiratory infection that was treated symptomatically. A full neurological exam, lab tests, and a CT scan of the brain found no acute cause for her altered speech and tremor. She received a dose of the sedative midazolam through an IV and was sent home with a prescription for hydroxyzine, an antihistamine often used for anxiety, to take as needed.
Outpatient neurologists later learned that her stuttering had begun after she performed in the marching band at her first home football game. Over time, the stutter gave way to complete loss of her voice in every setting. Her singing voice, however, remained fully intact.
Normal Tests Pointed Doctors Toward the Mind
Psychogenic voice disorders are often considered a form of conversion disorder, also known as functional neurological disorder, in which psychological stress shows up as a physical symptom. The authors described the marching band performance as a potentially traumatic event and said the case underscores the complex relationship between trauma, anxiety and these disorders.
Her doctors tried several medications and eventually built a multidisciplinary treatment approach that included psychotherapy and speech therapy. Even so, the authors wrote, her symptoms persisted. They did note improvements after her dose of fluoxetine, prescribed for underlying anxiety, was increased to 30 mg.
Psychogenic voice disorders can take several forms. The voice may sound strained, raspy or very soft, or it may disappear entirely, and psychological difficulties usually underlie the problem, according to the University of Pittsburgh's voice center. Even fear of speaking in front of a large group can make a person temporarily lose their voice.
Why Singing Can Survive When Speech Fails
The case report does not explain exactly why singing was spared. But researchers have long noticed that singing and speaking can behave differently when speech breaks down.
Many people who stutter speak with far fewer disruptions, or none, when they sing, as speech scientists Nan Bernstein Ratner and Shelley B. Brundage explain in an overview of stuttering mysteries. Song stretches and links words together, follows a predictable beat, and relies on lyrics that are known in advance, all features that should logically ease fluency. Even so, they wrote, the reasons singing helps are still imperfectly understood.
The teen's stutter was not the developmental kind those researchers study, so the comparison has limits. Still, it illustrates that song can remain accessible even when ordinary speech falters.
A Treatment Gap the Authors Want Filled
Psychogenic voice loss itself is not unheard of. A case report on a 12-year-old boy in Jordan with psychogenic aphonia, or total voice loss, described the condition as rare, more common in girls and women, and usually preceded by a stressful life event. That boy regained his voice four weeks after starting speech therapy combined with psychotherapy. The report also cited a long-term study of 500 patients in which 82% regained their voice on the first day of voice therapy, and it stressed that early diagnosis matters.
That report also identified a previous episode of voice loss and a recent upper respiratory infection as possible predisposing factors. The Virginia teen had a mild respiratory infection shortly before her symptoms began, though her doctors did not claim it caused her condition.
Her course was far more stubborn. Reports cited by the Virginia authors describe voice therapy that starts with non-speech sounds such as coughing or laughing and builds toward words. The authors also noted that few case reports of psychogenic speech and voice disorders exist at all, which leaves clinicians with little published experience to draw on.
Anyone who suddenly loses their voice should see a clinician to rule out physical causes. The University of Pittsburgh's voice center notes that addressing the psychological causes is key to resolving the problem, with additional help from a speech pathologist or voice teacher as needed.
Key Questions Answered
What happened to the teenager?
After performing with her marching band, the 16-year-old developed a stutter that progressed to complete loss of her speaking voice, while her ability to sing remained intact.
What is a psychogenic voice disorder?
It is a voice problem with no physical cause in the vocal cords or brain, in which psychological factors disrupt voice production. It is often considered a form of conversion disorder.
Why is this case unusual?
Its authors said no prior published cases had examined losing the conversational voice while keeping the singing voice.
How was she treated?
Her doctors tried several medications along with psychotherapy and speech therapy. Her symptoms persisted, though the authors noted improvements after her fluoxetine dose for anxiety was increased.
Can people with psychogenic voice loss recover?
Many do, sometimes quickly with voice therapy, but responses vary. Anyone with sudden voice loss should be evaluated by a clinician.
Published by Medicaldaily.com
