Spasmodic Dysphonia

Spasmodic dysphonia — also called laryngeal dystonia — is a voice disorder that affects your larynx (voice box) and vocal cords. Your voice may break, sound tight and strained or very breathy when you speak. A rare condition, it affects around 500,000 people in the U.S.

Typically, your vocal cords vibrate when you talk, producing the sound of your voice. But with spasmodic dysphonia, the muscles controlling your vocal cords go into spasms without your control. The spasms can make your vocal cords come together too tightly, making your voice strained. Or, the spasms may make them too loose, making your voice breathy and weak. This condition can make it harder to speak and be understood.

Spasmodic dysphonia usually only affects conversational speech. Your voice will likely feel and sound normal when you’re singing, laughing or whispering.

Types of spasmodic dysphonia

The three types of spasmodic dysphonia are:

• Adductor spasmodic dysphonia (most common). This type makes your voice sound strained, tight and hoarse. It happens when spasms force your vocal cords too close together.
• Abductor spasmodic dysphonia. This type makes your voice sound weak or breathy. It happens when spasms keep your vocal cords too far apart.
• Mixed spasmodic dysphonia. Rarely, people have symptoms of both types of spasmodic dysphonia.

Any of these may also present with vocal tremor, which makes your voice sound shaky.

Symptoms of spasmodic dysphonia

Symptoms usually start in midlife (between ages 30 to 60). Voice changes may come and go, so you can’t predict when your voice will suddenly sound different. Your voice may sound:

• Strained and tight
• Hoarse and raspy
• Breathy, soft or like you’re whispering
• Broken because certain sounds cut off while you’re speaking
• Shaky or trembling

Stress, including the stress of talking on the telephone or with groups of people, or in noisy places, can make symptoms worse.

Spasmodic dysphonia causes

Spasmodic dysphonia starts in an area of your brain called the basal ganglia. This part of your brain helps coordinate involuntary muscle movements. Conditions that cause uncontrollable muscle movements because of faulty brain signals are called dystonias. This is why this condition is also called “laryngeal dystonia.”

The faulty signaling makes the muscles in your larynx and your vocal cords go into spasms.

Risk factors

Researchers don’t know what triggers spasmodic dysphonia. In some cases, it may be related to gene variants you inherit from your biological parents. About 1 in 4 people diagnosed have a family history of dystonia. It’s also possible that it occurs after an injury or sickness.

It’s three times more common in females.

How doctors diagnose spasmodic dysphonia

Diagnosis usually involves a team of healthcare providers. An otolaryngologist and a speech-language pathologist (SLP) will listen to you speak. They’ll check for breaks in your speech and other signs of the condition. They’ll also do a videostroboscopy. This imaging test shows how your vocal cords move when you talk.

A neurologist may check for other types of movement disorders.

How is spasmodic dysphonia treated?

Healthcare providers can’t cure spasmodic dysphonia. But there are treatments to ease vocal cord spasms. Treatments include:

• Botox^® injections (most common). Botox^® blocks the nerve signals that cause spasms, making it easier to talk. The effects usually last up to four months. You’ll need regular injections to keep seeing benefits.
• Voice therapy. An SLP can teach you exercises to improve how you use your voice. Voice therapy works best when you’re also getting Botox.
• Communication aids. You can use technology that makes your voice sound louder or that translates typed text into speech.

Surgery

There are two types of surgeries providers use to treat adductor spasmodic dysphonia (the type where your vocal cords are too close):

• Type II thyroplasty sets your vocal cords farther apart. A surgeon readjusts the supportive tissue in your voice box that holds your vocal cords in place.
• Selective laryngeal adductor denervation-reinnervation (SLAD-R) changes the pathway that nerve signals use to travel from your brain to your vocal cords. A surgeon disconnects some of the nerves you use to speak and reconnects them to a different nerve.

Surgery for spasmodic dysphonia is controversial because the benefits may not last very long for everyone. More research is needed to show that the benefits of surgery outweigh the risks.

When should I see my healthcare provider?

Contact your healthcare provider if you have unexplained voice changes. Voice strain or breaks can be a sign of something temporary, like laryngitis. But if things don’t improve within a couple of weeks, it’s time to see a provider.

What can I expect if I have spasmodic dysphonia?

Spasmodic dysphonia is a lifelong condition. Typically, symptoms develop gradually, level off and then remain the same for the rest of your life. Sometimes, the spasms disappear for a period. But they usually return at some point.

The best way to deal with spasmodic dysphonia is to work with your care team to manage it. For most people, regular Botox injections and voice therapy help.

Your healthcare provider can explain your options.

Is there anything I can do to feel better?

Here are some things you can do if you’re living with spasmodic dysphonia:

• Learn your voice. Some people notice symptoms ease when they’re chewing or supporting their head while talking or singing. It’s possible that there are similar “hacks” that work for you.
• Practice self-care. Being too tired or stressed can worsen the symptoms of spasmodic dysphonia. Getting enough rest and caring for your mental health can help.
• See a counselor. A counselor can help you cope with the impact your condition has on your ability to work and socialize.
• Be open with others. You may feel self-conscious about your voice. If your voice changes mid-conversation, consider explaining why it happens. Most people will be understanding.
• Join support groups. Support groups can connect you with others who understand the challenges of spasmodic dysphonia or other voice disorders.

Is spasmodic dysphonia a symptom of Parkinson’s?

No. Spasmodic dysphonia is different from Parkinson’s disease. Parkinson’s causes you to gradually lose muscle control throughout your body. But spasmodic dysphonia only affects your voice. Instead of getting worse over time, symptoms usually level off.

Is spasmodic dysphonia a disability?

It can be. Spasmodic dysphonia may be considered a disability if it interferes with your ability to do your job. Working with a counselor who specializes in disability-related issues can help you understand what may be involved.