What is 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 having severe trouble getting words out.

It is a lifelong condition. It most often affects women, particularly between the ages of 30 and 50.

There are three types of spasmodic dysphonia:

• Adductor spasmodic dysphonia. This is the most common type. It causes sudden involuntary spasms that trigger the vocal cords to stiffen and slam closed. The spasms interfere with the 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 you whisper, laugh, sing, speak at a high pitch, or speak while breathing in.

• Abductor spasmodic dysphonia. This type causes sudden involuntary spasms that trigger 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 you laugh or sing.

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

What causes spasmodic 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.

What are the symptoms of spasmodic dysphonia?

Symptoms 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.

How is spasmodic dysphonia diagnosed?

A speech-language pathologist may test voice production and quality. A doctor who specializes in the ear, nose, and throat (called an ENT or otolaryngologist) can diagnose the disorder. Along with a full health history and physical exam, your health care provider may check the vocal folds using flexible laryngoscopy. 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.

How is spasmodic dysphonia treated?

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 with moderate success in some people. Injecting botulinum toxin directly into the affected muscles of the voice box has also had some success. But it must be done on a regular basis (every 3 to 6 months, depending on the person). Speech therapy can be helpful in severe cases where there is muscle constriction with neurologic spasms. A neurologist may be involved when there is a vocal tremor along with spasmodic dysphonia. Tremors can be treated with certain medicines. There is ongoing research into this disorder, with the goal of reaching a treatment that will give lasting relief or possibly a cure.

Living with spasmodic dysphonia

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 and cellphone apps that can translate text into speech.

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

Key points about spasmodic dysphonia

• Spasmodic dysphonia is a voice disorder that makes talking difficult.

• It causes involuntary spasms of the voice box.

• Specialists, such as speech-language pathologists, ENTs, and possibly neurologists, should be part of your care team.

• The goal of treatment is to reduce symptoms and aid communication.

Next steps

Here are some tips to help you get the most from a visit to your health care provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you don't take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.