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Nonorganic

Nonorganic is a term used to describe an apparently physical disorder that in fact is not arising from the organ or body part but from an abnormality of the use or presentation of that body part.

Examples

  1. Nonorganic voice disorder, in which the larynx is structurally and neuromuscularly normal, but the sound is absent or very abnormal.
  2. Nonorganic breathing disorder, tracheal, in which breathing noises made in the trachea mimic asthma.
  3. Nonorganic dysphagia, in which swallowing function is normal but factitious events occur during the voluntary phases of swallowing.

See also: laryngeal nonorganic breathing disorder; nonorganic overlay; nonorganic cough; nonorganic asthma;

Nonorganic Voice Disorder

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Nonorganic voice

Nonorganic voice (1 of 3)

Panoramic view of normal breathing position with abducted vocal cords.
Vocal cord position for normal voice

Nonorganic voice (2 of 3)

Vocal cord position for normal voice.
Abnormal voice created on a non-organic (functional) basis

Growling voice (3 of 3)

Abnormal voice created on a non-organic (functional) basis: Vibratory blur of supraglottic tissues – especially arytenoid mounds – create an inappropriate, rough, growling voice.

Example 2

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Normal vocal cord posturing

Nonorganic voice (1 of 2)

Normal vocal cord posturing with, accordingly, normal voice production.
Nonorganic voice

Nonorganic voice (2 of 2)

Same patient, moments earlier in the same examination, with nonorganic vocal cord posturing and, accordingly, nonorganic voice disturbance.

Example 3

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Nonorganic voice

Nonorganic voice (1 of 4)

Breathing position, standard light, showing normal morphology and mucosa.
Nonorganic voice

Voicing position (2 of 4)

During this moment of appropriate vocal cord posturing and tensing, we see normal adduction and hear normal voice.
Nonorganic vocal cord posturing

Nonorganic vocal cord posturing (3 of 4)

Strobe light, voicing, open phase of vibration. Nonorganic vocal cord posturing (see separate vocal processes) combined with nonorganic flaccidity (non-contraction) of the thyroarytenoid muscles such that the cords flap like unsecured sails in the wind (luffing).
Nonorganic voice

Flaccidity is gone (4 of 4)

Only moments later, normal tension is returned volitionally to the vocal cords. The flaccidity is gone and vocal cord vibration and resulting voice return to normal.

Nonorganic Breathing Disorder, Tracheal

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distal trachea at the carina

Nonorganic breathing disorder, tracheal (1 of 2)

View of the distal trachea at the carina (where the windpipe divides into the right and left mainstem bronchi). Orienting arrow at the base of the carina.
tracheoesophageal party wall bulges inward

Nonorganic breathing disorder, tracheal (2 of 2)

With exhalation, the tracheoesophageal party wall bulges inward to largely obstruct the right mainstem bronchus. The result is convincing, but nonorganic, wheezing. This is suspected from the patient’s affect (e.g., surprising nonchalance and distractibility) and because the wheezes auscultate more loudly over the central chest than in the periphery. (In this slightly closer view, an arrow again indicates the base of the carina.)

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Persistent Coughing as a “Tool” (Nonorganic Cough)

Cough can have many causes—but one often-overlooked type is nonorganic cough. This refers to coughing that’s behavioral, often with identifiable secondary gain, rather than its being rooted in a physical disorder.

In this video, Dr. Bastian explains how to recognize nonorganic cough and outlines a practical, systematic approach to its diagnosis and management.

voice loss YT Thumbnail

Functional Dysphonia (Nonorganic): A Cause for Unexplained Voice Loss

This video gives an example of a patient who had been having a voice problem for several months. The clinician discovered that her voice problem was a nonorganic voice disorder, also called functional dysphonia. This kind of disorder is caused not by any abnormality of the larynx’s physical structures, but instead by an abnormal use of those physical structures.

You will see what the larynx looks like when a person with this kind of disorder makes voice, you will hear the clinician beginning to coax out the patient’s normal voice, and you will hear the patient learning to control this re-discovered normal voice.

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