Spasmadic Dysponia

Spasmodic dysphonia (SD) is a voice disorder. It causes involuntary spasms in the muscles of the voice box or larynx. The voices of people with spasmodic dysphonia can vary in quality and sound, ranging from difficulty saying a word or two to being unable to talk at all. Often, however, the disorder causes the voice to break, and have a tight, strained or strangled quality. It also feels difficult or effortful for the person with SD to speak. The disorder most commonly affects women, although men can be affected as well.

Although SD is considered a life-long condition, effective treatment is available and most patients live with minimal symptoms and achieve close to normal communication function. 

What causes spasmodic dysphonia?

Although the cause of spasmodic dysphonia is still not exactly known, it is considered to be a disorder from within the nervous system. SD may occur along with other movement disorders in the same person, such as with tremor. Some research has suggested that the dysfunction occurs in the basal ganglia of the brain, which is an area that participates in coordination of muscle movement. Spasmodic dysphonia may be run in families or begin sporadically after an upper respiratory illness, injury to the voice box (such as surgery to the neck), extended and heavy voice use or general stress.

Three types of spasmodic dysphonia have been classified

• Adductor spasmodic dysphonia (AdSD). This is the most common type of SD, which causes sudden involuntary spasms to stiffen and shut the vocal folds. The spasms interfere with vibration and production of sound. Stress can make spasms worse, while activities such as whispering, laughing, singing and speaking at a high pitch can lessen them.

• Abductor spasmodic dysphonia (AbSD). This type causes sudden involuntary spasms that pull the vocal folds apart and open. This type also interferes with voice because vibration cannot happen when folds are open. In this case, air escapes much more quickly during speech, and the voice sounds weak, quiet and whispery. Much like AdSD, spasms are minimized during laughing and singing.

• Mixed spasmodic dysphonia. This type is considered to have fluctuations between, and components of, both AdSD and AbSD.

How is spasmodic dysphonia diagnosed and who should I get on my voice care team?

• A speech-language pathologist will test voice function and quality.
• A laryngologist (voice physician and surgeon) can diagnose the disorder using a comprehensive head, neck and voice evaluation, which typically includes:
  • A complete history
  • A complete physical exam of the head and neck region
  • Videostroboscopy
  • Imaging/X-rays, when warranted
  • Blood work/lab testing, when warranted
• A neurologist will check for underlying neurological problems that may be related.

How is spasmodic dysphonia treated?

Our laryngologist will discuss with you the best treatment based on your particular presentation.  However, injection of botulinum toxin (Botox®) is the most common and most reliable course of treatment. Other options to discuss with your doctor include surgery and supportive speech therapy. The goal of treatment is to minimize the voice-disruptive symptoms of SD and maximize efficiency of communication.

Have voice concerns or want to recommend someone you know? Call DeFatta ENT & Allergy at (715) 828-2368 for more information or to schedule an appointment with our expert voice surgeon.