Spasmodic Dysphonia

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What is spasmodic dysphonia?

Spasmodic dysphonia is a chronic (long-term) voice disorder. With spasmodic dysphonia, movement of the vocal cords is forced and strained resulting in a jerky, quivery, hoarse, tight, or groaning voice. Vocal interruptions or spasms, periods of no sound (aphonia), and periods when there is near normal voice occur.

What are the signs and symptoms of spasmodic dysphonia?

At first, symptoms may be mild. They may occur only occasionally. Later on, they may worsen and become more frequent before they even out. Symptoms may be worse when a person is tired or stressed. They may be greatly reduced or even disappear, for example, during singing or laughing.

Spasmodic dysphonia is a disorder characterized by involuntary movements of one or more muscles of the larynx or voice box. The first signs of spasmodic dysphonia are most often found in individuals between 30 and 50 years old. More women appear to be affected by spasmodic dysphonia than men. Voice spasms fluctuate in severity. They may lessen for hours or even days at a time.

How is spasmodic dysphonia diagnosed?

There is no simple test for spasmodic dysphonia. Diagnosis is based on the presence of the typical signs and symptoms described above and the absence of other conditions that can produce similar problems. The best evaluation involves a team approach and includes:

  • a speech-language pathologist (SLP) to evaluate voice production and voice quality,
  • an otolaryngologist (ear, nose, and throat specialist) to examine the vocal cords and their movement, and
  • a neurologist who looks for signs of neurological problems.

What treatments are available for spasmodic dysphonia?

At present, there is no cure for spasmodic dysphonia. However, several treatment options do exist for voice improvement.

Repeat injections of small doses of botulinum toxin (Botox) into one or both vocal cords are frequently recommended and peformed by doctors. Botox weakens the laryngeal muscles and results in a smoother, less effortful voice because of less forceful closing of the vocal cords. Temporary breathiness or difficulty swallowing sometimes occurs for a short time after injection. Treatment by an SLP may also be recommended following injections to optimize voice production.

Find out more information about Botox, including some recent warnings about its use.

Psychological or psychiatric counseling is most useful when acceptance of the disorder and learning coping techniques are the desired goals. Career or vocational counseling may also be advised for persons who fear that the disorder threatens their occupation. Participation in local self-help support groups can also promote adjustment to the problem and provide contact with excellent sources of information.

What other organizations have information about spasmodic dysphonia?

This list is not exhaustive, and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA.

What causes spasmodic dysphonia?

Symptoms come from more than one source. Some people appear to have nervous system changes that produce an organic tremor of the vocal cords. Others may have dystonia, another kind of neurologic disorder that creates abnormal muscle tone. In rare cases, people can have spasmodic dysphonia symptoms because of acute or chronic life stress.

When not used for talking, the vocal cords of people with spasmodic dysphonia are normal in appearance and function. However, when the vocal cords are brought together for talking, their movement is uncontrolled.

How effective are treatments for spasmodic dysphonia?

Speech-language pathology services alone are most helpful when symptoms are mild. Techniques such as relaxation, breath control, maintaining a steady flow of air from the lungs during voice production, and pitch and loudness modifications can help improve the person's voice.

Recent studies have shown that cutting of the recurrent laryngeal nerve to paralyze one vocal cord appeared to reduce the force of vocal cord closure. There was a return of voice symptoms within 6 months to 3 years of surgery in almost two thirds of these patients. Many patients were worse than before. Speech-language pathology treatment was often recommended after surgery.

ASHA has written a treatment efficacy summary on voice disorders [PDF] that describes evidence about how well treatment works. This summary is useful not only to individuals with voice disorders and their caregivers but also to insurance companies considering payment for much needed services for voice disorders.

What do SLPs do when working with individuals with spasmodic dysphonia?

The Preferred Practice Patterns for the Profession of Speech-Language Pathology outline the common practices followed by SLPs when engaging in various aspects of the profession. The Preferred Practice Patterns for voice assessment and intervention are outlined in sections 34 and 35.