Spasmodic Dysphonia

In 1997 I developed a neurological condition called spasmodic dysphonia. for several years it affected my speaking voice. It has now progressed to impact my singing voice. Here is some information about the disorder.

Spasmodic Dysphonia (SD) is a focal form of dystonia. Dystonia is the general neurological term for a variety of problems characterized by excessive contraction of muscles with associated abnormal movements and postures. Other focal dystonias include blepharospasm (involving the eyelids), oromandibular dystonia, (involving the jaw and tongue), cervical dystonia or spasmodic torticollis (involving the neck), and writer's cramp (involving the hand). These forms of dystonia may appear in combination with spasmodic dysphonia.

The two types of recognized spasmodic dysphonia are adductor spasmodic dysphonia and abductor spasmodic dysphonia. Adductor SD causes an intermittent excessive closing of the vocal folds during vowel sounds in speech; while in abductor SD, there is a prolonged vocal-fold opening during voiceless consonants. The control problems of the vocal cords result in different speech symptoms in the two types of disorder. There are three subtypes of SD, which have been identified by clinicians. One is a combination of adductor and abductor symptoms in which an individual may demonstrate both types of spasms as he/she speaks. In a second subtype, SD symptoms are accompanied by a voice tremor. A third subtype involves a primary voice tremor that is so severe the patient experiences adductor voice stoppages during the tremor.

The cause of spasmodic dysphonia is unknown. The general medical consensus is that SD is a central nervous system disorder and a focal form of dystonia. Dystonia is the general neurological term for a variety of problems characterized by excessive contraction of muscles with associated abnormal movements and postures.

Dystonia disorders are thought to originate in the area of the brain called the basal ganglia, that area of the brain that helps coordinate movements of the muscles throughout the body.

Anyone, regardless of race, age, or ethnicity, can manifest symptoms of SD. It is estimated that 50,000 persons in North America are affected by SD, but this number may be higher due to ongoing misdiagnosis or undiagnosed cases of the disorder.

Spasmodic dysphonia is reported to be one of the most frequently misdiagnosed conditions in Speech-Language Pathology. Because there is no definitive test for the SD, the diagnosis rests on the presence of characteristic clinical symptoms and signs in the absence of other conditions that may mimic spasmodic dysphonia.

At this time, there is no cure for SD, but treatments are available. These treatments can improve the ability to speak, [but make singing impossible]. Botulinum toxin, a biological product, is injected into specific muscles where it acts to reduce the involuntary contractions that cause the symptoms of spasmodic dysphonia. The injections weaken muscle activity sufficiently to reduce a spasm but not enough to cause paralysis. Local injections of botulinum toxin (BTX) into the vocal cord muscles have proven to be the most effective treatment for spasmodic dysphonia. The treatment weakens the vocal muscles so that spasms are greatly diminished and speech is greatly improved.

The treatment can also reduce the breathiness and help decrease the effort required to speak. Surgery for spasmodic dysphonia has recently been re-examined as a form of treatment for people for whom botulinum toxin injections are no longer providing relief of symptoms. Selective Laryngeal Adductor Denervation-Reinnervation surgery involves cutting the nerve to the affected vocal cord and re-innervating the muscle with another muscle to prevent muscle atrophy. For some people who have undergone the surgery, symptoms have returned and follow-up with botulinum toxin injections was needed. Studies are ongoing to determine the effectiveness of this surgery.

General voice relaxation techniques and speech therapy may play an adjunct role in the treatment of spasmodic dysphonia. These include reducing one's vocal effort, loudness, intonation, and rate of utterance while increasing pause time between phrases. These techniques can only be reinforced and adapted if they do not intrude on the vocal naturalness.

Traditional western practices have long been effective in diagnosing problems and assigning treatments but may do little to address how patients live on a daily basis. Medical fields are slowly incorporating a wider range of knowledge to include treatments outside of the traditional scope to better assist patients and to treat the "whole person" - mind, body, and spirit. Complementary therapy may play an active role in the treatment of SD, and it is intended to be used in conjunction with traditional therapies.