Spasmodic Dysphonia

Overview

What is spasmodic dysphonia?

Spasmodic dysphonia is a chronic (long-term) neurological speech disorder. It changes the way your voice performs and sounds when you speak. The condition may also be called spastic vocal cords or spastic dysphonia.

In some people with spasmodic dysphonia, voice changes every few sentences or as often as every word. In severe cases, the condition can make a person difficult to understand.

Who might get spasmodic dysphonia?

Spasmodic dysphonia can start at any age, but it usually begins in middle to late age (40s, 50s or 60s). For unknown reasons, it affects women more than men.

How common is spasmodic dysphonia?

The condition is rare, affecting only about 1 person per 100,000.

Symptoms and Causes

What causes spasmodic dysphonia?

Scientists aren’t sure what causes spasmodic dysphonia. But they believe it’s neurological (related to a problem in an area of the brain, specifically the basal ganglia). Researchers are exploring neurological causes, as well as a possible genetic link.

Physicians and scientists do understand how spasmodic dysphonia happens. If you have the condition, the muscles in the larynx (voice box) can spasm either open or closed when you try to talk. The sudden, involuntary spasms can make the vocal cords (folds) move in abnormal ways, which affects your voice. The spasms that cause the vocal changes may come and go for no clear reason. There's been an association with stress and increased spasms.

However, the larynx often behaves normally during other activities, such as:

  • Breathing.
  • Crying.
  • Humming.
  • Laughing.
  • Singing.
  • Swallowing.

Are there different types of spasmodic dysphonia?

The condition can happen in a few different ways:

  • Adductor spasmodic dysphonia. This is the most common type. Spasms cause the vocal cords to slam together and tighten, making it difficult for them to create sounds. Voices can often sound strained or tight and break on different words.
  • Abductor spasmodic dysphonia. Spasms make the vocal folds stay open, so they can’t vibrate and produce sound. Voices can sound breathy and break on different words.
  • Mixed spasmodic dysphonia. This is a rare combination of the adductor and abductor types.

What are the symptoms of spasmodic dysphonia?

Most cases of spasmodic dysphonia start gradually. Once symptoms begin, they may worsen for about 18 months and then stay about the same.

People with spasmodic dysphonia have described their voices as:

  • Breathy or whispered.
  • Broken or jerky.
  • Hoarse.
  • “Not right.”
  • Shaky or trembling.
  • Strained.
  • Tight or strangled.

Diagnosis and Tests

How is spasmodic dysphonia diagnosed?

Spasmodic dysphonia is difficult to diagnose because the larynx looks normal, so tests like MRI and CT scan don't show anything. Plus, the symptoms can be similar to other disorders.

Diagnosis may require a healthcare team, including:

  • Neurologist, a doctor who specializes in the brain and nervous system.
  • Otolaryngologist (ENT), a doctor who specializes in the ear, nose, throat, head and neck. Often a laryngologist (sub-specialty of ENT) will be needed to confirm the diagnosis.
  • Speech-language pathologist, a healthcare professional who addresses voice, speech and language disorders.

What tests might I have for spasmodic dysphonia?

An otolaryngologist may perform a test called a videostroboscopy to look at your larynx and listen to your voice. The specialist inserts a small, lit tube through your nose and into the back of your throat. It shows the larynx and the vocal cords, as well as how they move during speech and other activities.

The specialists will listen to your voice. They may use imaging tests such as MRI to look for any problems in the brain but this isn't commonly done.

Management and Treatment

How is spasmodic dysphonia treated?

There's no cure for spasmodic dysphonia. But some treatments may ease the symptoms or make the condition less severe, such as:

  • Antianxiety medications. Some medications taken by mouth may lessen anxiety in people who have symptoms of spasmodic dysphonia as stress will worsen symptoms.
  • Injections of botulinum toxin (BOTOX®). BOTOX treatment involves injecting small amounts of a toxin into the vocal folds, which can relax the muscles. Each treatment can last a few months.
  • Myofascial release. This technique applies pressure on the outside of the throat and stretches the muscles to lessen symptoms.
  • Selective laryngeal adductor denervation-re-innervation (SLAD-R). This surgery involves cutting specific nerves used during speech, then reconnecting them in different ways. This may break nerve path from the brain to the vocal cords.
  • Thyroplasty. There are two types that can help. This surgery either separates the vocal folds to prevent the larynx from closing too tightly or puts the vocal folds closer together to prevent them from opening too much
  • Voice therapy. A speech-language pathologist can teach you ways to alter the way you speak to lessen the condition’s effects.
Care at Cleveland Clinic

Prevention

How can I prevent spasmodic dysphonia?

Spasmodic dysphonia can't be prevented. There are no known risk factors or lifestyle changes that can lessen your chances of developing it.

Outlook / Prognosis

How long will I have spasmodic dysphonia?

Spasmodic dysphonia is a chronic, lifelong condition. Even with successful treatments, the symptoms will come back.

Researchers are working to learn more about spasmodic dysphonia. They're exploring its possible causes, as well as better ways to diagnose and treat it.

Living With

How can I cope with spasmodic dysphonia?

People with spasmodic dysphonia have several options to cope with the effects of the condition, such as:

  • Counseling. A counselor may help you cope with the symptoms and their effects on your ability to work and socialize. Some counselors specialize in how to adjust in your career.
  • Self-care. Being tired or stressed out can worsen the symptoms of spasmodic dysphonia. Take good care of yourself and get enough rest to help control symptoms.
  • Stay connected. Try not to let the condition stop you from getting together with friends and family. As you spend time with them, people will get used to your altered voice.
  • Support groups. Support groups can connect you with other people who understand the challenges of vocal dysphonia.
  • Voice devices. Some devices can help people with spasmodic dysphonia function better. For example, some devices amplify a person’s voice (like a speaker) in person or over the phone. Additionally, some computer software and smartphone apps can translate typed text into speech.

A note from Cleveland Clinic

Spasmodic dysphonia is a speech disorder that changes the way your voice performs and sounds. If you're having trouble with your voice, talk to a healthcare provider. A team of specialists can diagnose the condition and offer various treatments and ways to cope.

Last reviewed by a Cleveland Clinic medical professional on 10/21/2021.

References

  • American Speech-Language-Hearing Association. Spasmodic Dysphonia. (https://www.asha.org/public/speech/disorders/Spasmodic-Dysphonia/) Accessed 11/15/2021.
  • National Institute on Deafness and Other Communication Disorders. Spasmodic Dysphonia. (https://www.nidcd.nih.gov/health/spasmodic-dysphonia) Accessed 11/15/2021.
  • National Spasmodic Dysphonia Association. Spasmodic Dysphonia. (https://dysphonia.org/voice-conditions/spasmodic-dysphonia/) Accessed 11/15/2021.
  • Ludlow C. Spasmodic Dysphonia: A Laryngeal Control Disorder Specific to Speech. (https://www.jneurosci.org/content/31/3/793) J Neurosci. 2011;31:793-797. Accessed 11/15/2021.

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