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We have all experienced problems with our voices, times when the voice is hoarse or when sound will not come out at all! Colds, allergies, bronchitis, exposure to irritants such as ammonia, or cheering for your favorite sports team can result in a loss of voice. But, people with spasmodic dysphonia, a chronic voice disorder, face the persistent question: With spasmodic dysphonia, movement of the vocal cords is forced and strained resulting in a jerky, quivery, hoarse, tight, or groaning voice. Vocal interruptions or spasms, periods of no sound (aphonia), and periods when there is near normal voice occur. At first, symptoms may be mild and occur only occasionally. Later on, they may worsen and become more frequent before they stabilize. Even then, symptoms may be worse when a person is tired or stressed. Or, they may be greatly reduced or even disappear, for example, during singing or laughing. Spasmodic dysphonia is a disorder characterized by involuntary movements of one or more muscles of the larynx or voice box. The first signs of spasmodic dysphonia are most often found in individuals between 30 and 50 years old. More women appear to be affected by spasmodic dysphonia than man (1). The effortful voice spasms of spasmodic dysphonia fluctuate in severity and may remit for hours or even days at a time (2). When not used for talking, the vocal cords of people with spasmodic dysphonia are normal in appearance and function. However, when the vocal cords are brought together for talking, their movement is uncontrolled. Symptoms come from more than one source. Some people appear to have nervous system changes that produce an organic tremor of the vocal chords. Others may have dystonia, another kind of neurologic disorder that creates abnormal muscle tone. In rare cases, people can have spasmodic dysphonia symptoms because of acute or chronic life stress. Diagnosis There is no simple test for spasmodic dysphonia. Rather, diagnosis is based on the presence of the typical signs and symptoms described above and the absence of other conditions that can produce similar problems. The best evaluation involves as interdisciplinary approach and includes a speech-language pathologist to evaluate voice production and voice quality, an otolaryngologist (ear, nose, and throat specialist) to examine the vocal cords and their movement, and a neurologist who looks for signs of neurological problems. At present, there is no cure for spasmodic dysphonia. However, several treatment options do exist for voice improvement. Repeat injections of small doses of botulinum toxin (Botox) into one or both vocal cords is frequently recommended. Botox weakens the laryngeal muscles and results in a smoother, less effortful voice because of less forceful closing of the vocal cords. Temporary breathiness or difficulty swallowing sometimes occurs for a short time after injection. Treatment by a speech-language pathologist may also be recommended following injections to optimize voice production. Speech language pathology services alone are most helpful when symptoms are mild. Clients learn techniques such as relaxation, breath control, maintaining a steady flow of air from the lungs during voice production, and pitch and loudness modifications. Surgical cutting of the recurrent laryngeal nerve to paralyze one vocal cord initially met with good results by reducing the force of vocal cord closure. Surgery was frequently followed by speech-language pathology treatment. Long-term follow-up has shown return of voice symptoms within 6 months to 3 years of surgery in almost two thirds of these patients with a disturbing number who were worse than before. Psychological or psychiatric counseling is most useful when acceptance of the disorder and learning coping techniques are the desired goals. Career or vocational counseling may also be advised for persons who fear that the disorder threatens their occupation. Participation in local self-help support groups can also promote adjustment to the problem and provide contact with excellent sources of information. |
