What Is Spasmodic Dysphonia

Overview

Spasmodic dysphonia, or laryngeal dystonia, is a rare voice disorder. It causes involuntary muscle spasms in the larynx, disrupting vocal cord vibrations and leading to voice interruptions.¹ The vocal folds are situated in the voice box (larynx). When you speak, air from the lungs passes through these folds to the mouth, causing them to vibrate and create sound. Anything that hinders this vibration can lead to voice issues.
Dystonia is a neurological disorder where specific movements trigger muscle spasms in the central nervous system (CNS).²
According to the American Speech-Language-Hearing Association, Spasmodic dysphonia (SD) is a chronic voice disorder characterized by vocal fold spasms or tightening, resulting in irregular, shaky, hoarse, or tight speech and intermittent normal voice as it can come and go.  This condition is long-lasting and can develop suddenly with severe symptoms or begin with mild symptoms that worsen over time.¹

Types of spasmodic dysphonia

There are three main types.

• Adductor (vocal cords slam together) Spasmodic Dysphonia is mostly common, occurring in almost 90% of people with spasmodic dysphonia. It causes voice interruption when you speak, as the vocal cords sometimes squeeze too tightly.³
• Abductor (vocal cords remain open) Spasmodic Dysphonia is not common and causes occasional gaps in speech where there's a pause in the sound when transitioning from silent consonants to the following vowels.³
• Mixed (a combination of both) Spasmodic Dysphonia is a very rare combination of both adductor and abductor symptoms, with vocal cords struggling to open and close properly.^{1 2}

Causes and symptoms

Causes

Spasmodic dysphonia is believed to happen because of issues in a part of the brain called the basal ganglia. The basal ganglia help with muscle movements in the body. Recent research has shown problems in other brain areas linked to spasmodic dysphonia, including parts of the brain's outer layer that manage muscle commands and how they work with sensory information.

Spasmodic dysphonia is sometimes believed to be passed down in families, although this has not been pinpointed to a specific gene. A change in a gene that causes other forms of dystonia has also been linked to spasmodic dysphonia.¹

Common symptoms are:

• Voice interruptions ²
• Tight or strained voice
• Breathiness
• Vocal tremors

Diagnosis

Diagnosing spasmodic dysphonia can be tricky because its symptoms often resemble those of other voice problems. The diagnosis typically involves a team of specialists, including:

• An ear, nose, and throat (ENT) doctor will use a small lighted tube to examine the throat and vocal cords (fiberoptic nasolaryngoscopy).
• A speech therapist, who will assess voice issues.
• A neurologist will check for signs of dystonia and other brain-related movement problems.

Treatment and management of spasmodic dysphonia

Currently, there is no cure for spasmodic dysphonia, but treatments can help manage its symptoms.

• The most common treatment involves injecting tiny amounts of botulinum toxin directly into the affected larynx muscles. This toxin weakens muscles by blocking nerve signals and can provide relief for about three to four months, but it requires repeat injections. Initial side effects may include temporary voice weakness and swallowing issues, which usually improve with time. However, this treatment is more effective for some types of spasmodic dysphonia than others.^2,3
• For milder cases, behavioural therapy (voice therapy) can help reduce symptoms.
• Psychological counselling may assist in accepting and coping with voice issues.
• Augmentative and assistive devices can aid communication.
• In rare cases when other methods don't work, surgery on the larynx may be considered, but the outcomes can vary, and there's no one-size-fits-all solution.

Living with spasmodic dysphonia

Spasmodic dysphonia is an enduring condition that alters your voice, and in severe cases, it can hinder your ability to communicate effectively. To manage this condition, consider the following strategies:

• It's crucial to take good care of yourself and ensure you get enough rest because fatigue and stress can exacerbate the symptoms of spasmodic dysphonia.
• Seeking support from a counsellor can be beneficial in helping you deal with the symptoms and addressing their impact on your professional and social life. Some counsellors specialise in providing guidance on adjusting to work-related challenges.
• You might feel self-conscious about your voice, especially if it changes unexpectedly during a conversation. In such situations, don't hesitate to explain the reason behind these changes to those you're communicating with.
• Consider becoming part of support groups, which can connect you with individuals who have firsthand experience with the unique challenges associated with spasmodic dysphonia.

Future research and directions

Ongoing research seeks a better grasp of spasmodic dysphonia, its causes, and improved diagnostic and treatment methods. Scientists supported by The National Institute on Deafness and Other Communication Disorders (NIDCD) are investigating brain abnormalities and genes associated with the condition to enhance detection and diagnosis. Additionally, they're exploring new therapies and surgical options, like identifying specific brain areas that control unusual larynx muscle activity and developing medications to address the abnormal brain activity linked to spasmodic dysphonia. Research is also underway to understand if problems with auditory and sensory feedback contribute to the condition's symptoms.

FAQs

Who is predisposed to spasmodic dysphonia?

It can affect anyone but is more common in women and typically starts between ages 30 and 50.

Is there a cure for spasmodic dysphonia?

There is no cure, but treatments, such as botulinum toxin injections, voice therapy, and surgery, can help manage symptoms.

What causes spasmodic dysphonia?

The exact cause is not fully understood, but it's believed to involve abnormal brain functioning in areas like the basal ganglia.

Can spasmodic dysphonia run in families?

Yes, in some cases, there is a familial connection, but a specific gene for spasmodic dysphonia has not been identified.

How can individuals with spasmodic dysphonia cope with the condition?

Coping strategies include self-care to manage stress, counselling for emotional support, explaining voice changes to others, and considering support groups.

Can spasmodic dysphonia be completely treated with surgery?

Surgery on the larynx may be considered in some cases, but results vary, and it's not a guaranteed solution for everyone.

Can children develop spasmodic dysphonia?

While it's more common in adults, children can also develop spasmodic dysphonia.

What should I do if I suspect I have spasmodic dysphonia?

If you suspect you have spasmodic dysphonia or are experiencing voice problems, consult with a healthcare professional for a proper diagnosis and treatment options.

Summary

Spasmodic dysphonia is a chronic voice disorder characterised by involuntary muscle spasms in the larynx, leading to disruptions in speech. The exact cause is not fully understood but is thought to involve abnormal brain functioning in areas like the basal ganglia. Diagnosis typically involves a medical team, including an otolaryngologist, speech-language pathologist, and sometimes a neurologist. Although there is no cure for spasmodic dysphonia, various treatments can help manage its symptoms, including botulinum toxin injections, voice therapy, and, in rare cases, surgery. Coping strategies involve self-care, counselling, and support groups. While more common in adults, spasmodic dysphonia can also affect children. If someone suspects they have spasmodic dysphonia or is experiencing voice problems, it's essential to consult with a healthcare professional for proper diagnosis and treatment options.