Spasmodic Dysphonia

Spasmodic dysphonia is a voice disorder. It causes involuntary spasms in the muscles of the voice box or larynx.  This causes the voice to break, and have a tight, strained, or strangled sound. 

Spasmodic dysphonia can cause problems ranging from trouble saying a word or two to not being able to talk at all.

Spasmodic dysphonia is a life-long condition. It most often affects women, particularly between the ages of 30 and 50.

There are 3 types of spasmodic dysphonia:

• Adductor spasmodic dysphonia. This is the most common type. It causes sudden involuntary spasms that cause the vocal cords to stiffen and slam closed. The spasms interfere with vibration of the vocal cords and with making sound. Stress can make spasms worse. Speech sounds are strained and full of effort. Spasms don't happen when whispering, laughing, singing, speaking at a high pitch, or speaking while breathing in.

• Abductor spasmodic dysphonia. This type causes sudden involuntary spasms that cause the vocal cords to open. Vibration can’t happen when cords are open so making sound is difficult. Also, the open position lets air escape during speech. Speech sounds are weak, quiet, and whispery. Spasms don't happen when laughing or singing.

• Mixed spasmodic dysphonia. This is a mix of symptoms of both types of dysphonia.

The exact cause of spasmodic dysphonia is not known. A nervous system disorder is thought to cause most cases. They may happen along with other movement disorders. Researchers think it may be caused by a problem in the basal ganglia of the brain. This is the area that helps coordinate muscle movement. Spasmodic dysphonia may be inherited. It may start after a cold or the flu, injury to the voice box, a long period of voice use, or stress.

Symptoms of spasmodic dysphonia vary depending on whether the spasms cause the vocal cords to close or to open. Speech that is strained or difficult, weak, quiet, or whispery, may be due to spasmodic dysphonia.

A speech-language pathologist may test voice production and quality. An otolaryngologist, a healthcare provider who specializes in the ear, nose, and throat, can diagnose the disorder. Along with a complete medical history and physical exam, checking the vocal folds using fiberoptic nasolaryngoscopy may be done. This involves using a lighted tube passed through the nose into the voice box to check movement of the vocal folds during speech. A neurologist may check for underlying neurological problems.

The goal of treatment is to reduce symptoms of the disorder. Surgery to cut one of the nerves of the vocal fold has been used. Injecting botulinum toxin directly into the affected muscles of the voice box has had some success. Speech therapy is also a key part of treatment.

Difficulty speaking can cause stress. Counseling may help you learn to cope. Support groups can help with the process. If speech is very hard or impossible, other devices can aid communication. Technological advances include computer software or cell phone apps that can translate text into speech.

Work with your speech-language pathologist, otolaryngologist, or neurologist to develop the best treatment for your needs.