TABLE 162 m Disorders of Speech

Disorders of speech fall into three groups: those affecting (1) the voice, (2) the articulation of words, and (3) the production and comprehension of language.

Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. For example, a person may be hoarse or only able to speak in a whisper. Causes include laryngitis, laryngeal tumors, and a unilateral vocal cord paralysis (Cranial Nerve X).

Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Words may be nasal, slurred, or indistinct, but the central symbolic aspect of language remains intact. Causes include motor lesions of the central or peripheral nervous system, parkinsonism, and cerebellar disease.

Aphasia refers to a disorder in producing or understanding language. It is often caused by lesions in the dominant cerebral hemisphere (usually the left).

Compared below are two common types of aphasia: (1) Wernicke's, a fluent (receptive) aphasia, and (2) Broca's, a non-fluent (or expressive) aphasia. There are other less common kinds of aphasia, which may be distinguished from each other by differing responses on the specific tests listed. Neurologic consultation is usually indicated.

Wernicke's Aphasia

Broca's Aphasia

Qualities of Spontaneous Speech

Word Comprehension



Reading Comprehension Writing

Location of Lesion

Fluent; often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible.






Posterior superior temporal lobe

Nonfluent; slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped.

Fair to good Impaired

Impaired, though the patient recognizes objects

Fair to good


Posterior inferior frontal lobe

While it is important to recognize aphasia early in your encounter with a patient, its full diagnostic meaning does not become clear until you integrate this information with your neurologic examination.

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