"I can come by here and have a couple of polyps lasered off my vocal cords and then go straight to work."
— Daryl Collins, age 53

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Spasmodic Dysphonia

Anatomy of the Condition:

Dystonia is a neurological disorder which causes involuntary muscle movements. Spasmodic dysphonia is a form of dystonia that produces involuntary spasms of the vocal folds, resulting in disordered speech.

There are two typical forms of spasmodic dysphonia:

  • Adductor type is the most common form and is caused by the abrupt, involuntary contraction of the muscles that bring the vocal folds together. This results in closure of the vocal folds, which gives the person broken, strained speech and a tight quality to the voice.
  • Abductor type, which is less common, occurs when involuntary contractions in the muscles that open the vocal folds allow air to escape suddenly, resulting in breathy, whispery voice breaks.

Other, less common, forms of spasmodic dysphonia have been identified, including a combination of the two types.

Causes or Contributing Factors:

There is no known cause for spasmodic dysphonia. SD is believed to be a neurological disorder and therefore a result of abnormal functioning of the basal ganglia structure in the brain. Onset occurs without warning or explanation and is more prevalent among people in the 40- to 50-year-old age group, especially women.

Symptoms:

As discussed above, the key symptom for the adductor variety of SD is a halting, interrupted voice pattern. With the abductor type of SD, the voice has breathy voice breaks. Other symptoms may include a tight or constricted sounding voice, which is the result of the patient trying to control spasms. Symptoms may improve or worsen, depending on the time of day.

Diagnosis:

The condition is hard to diagnose and is frequently misdiagnosed. The disease often mimics other conditions or speech patterns, and appropriate diagnosis requires a thorough examination by an experienced team of voice specialists.

There is not a definitive test for the condition. Diagnosis depends on a combination of symptoms and evaluation by the clinical voice team.

Non-Operative Treatments:

Botox injections are one of the most effective treatments in recent years for both major forms of spasmodic dysphonia. The drug softens and weakens the vocal muscles, diminishing spasms. This treatment also reduces the wispiness associated with the abductor form of the disease.

The results of Botox may vary, but the drug normally takes effect 24-48 hours after the injections. First, the voice becomes soft and breathy for a period of several days to two weeks. Then the voice should get stronger and stronger, with fewer spasms. The duration of the effect is variable but will commonly last for three to four months before the patient will require the next injection.

Since Botox weakens vocal muscles, an initial side effect may be difficulty in swallowing. However, a speech pathologist can usually train the patient in alternative swallowing techniques.

Voice relaxation techniques and other speech therapies may sometimes be effective in lessening symptoms of the condition.

Operative Treatments:

In some instances, surgery may be recommended. A relatively new surgical option is selective laryngeal adductor denervation reinnervation. In this procedure, the nerves to the muscles bringing the vocal folds together are divided. Alternate neural tissue is then used to lessen the symptoms of spasmodic dysphonia.