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If aphonia and difficulty of both inspiration and expiration be present at the same time, there is certainly membranous occlusion.

A striking form of inability to co-ordinate muscles so as to enable them to perform their ordinary function is aphonia, or mutism, sometimes spoken of as hysterical mutism.

Slight forms of structural aphonia are of a catarrhal nature, resulting from more or less congestion and tumefaction of the mucous and submucous tissues of the larynx and adjoining parts.

The most prominent symptoms are hoarseness, aphonia, and dyspnœa, which in children may be paroxysmal.

If the recurrent laryngeal nerves are involved, unilateral or bilateral paralysis of the larynx may complicate the symptoms by cough, dyspnea, aphonia, and possibly septic pneumonia.