Spasmodic dysphonia: MedlinePlus Medical Encyclopedia URL of this page: //medlineplus.gov/ency/article/000753.htm Spasmodic dysphonia Spasmodic dysphonia is difficulty speaking due to spasms (dystonia) of the muscles that control the vocal cords. Causes Spasmodic dysphonia is sometimes due to psychological stress. Most cases result from a problem in the brain and nervous system that can affect the voice. The vocal cord muscles spasm, or contract, which causes the vocal cords to get too close or too far apart while a person is using their voice. Spasmodic dysphonia often occurs between ages 30 and 51. Women are more likely to be affected than men. Sometimes, the condition runs in the family. Symptoms The voice is usually hoarse or grating. It may waver and pause. The voice may sound strained or strangled, and it may seem as if the speaker has to use extra effort. This is known as adductor dysphonia. Sometimes, the voice is whispery or breathy. This is known as abductor dysphonia.

The problem may go away when the person laughs, whispers, speaks in a high-pitched voice, sings, or shouts. Some people have muscle tone problems in other parts of the body, such as writer's cramp. Exams and Tests An ear, nose, and throat doctor will check for changes in the vocal cords and other brain or nervous system problems. Tests that will usually be done include: Using a special scope with a light and camera to view the voice box (larynx) Voice testing by a speech-language provider Treatment Medicine that treats spasm of the vocal cord muscles may be tried. They appear to work in up to one half of people, at best. Some of these medicines have bothersome side effects. Botulinum toxin (Botox) treatments may help. Botulinum toxin comes from a certain type of bacteria. Very small amounts of this toxin may be injected into the muscles around the vocal cords. This treatment will often help for 3 to 4 months. Surgery to cut one of the nerves to the vocal cords has been used to treat spasmodic dysphonia, but it is not very effective. Brain stimulation may be useful in some people.

Alternative Names Spasmodic Dysphonia Spasmodic Dysphonia What do SLPs do when working with individuals with spasmodic dysphonia ? What is spasmodic dysphonia? Spasmodic dysphonia is a chronic (long-term) voice disorder. 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. What are the signs and symptoms of spasmodic dysphonia? At first, symptoms may be mild. They may occur only occasionally. Later on, they may worsen and become more frequent before they even out. Symptoms may be worse when a person is tired or stressed. 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 men. Voice spasms fluctuate in severity. They may lessen for hours or even days at a time. How is spasmodic dysphonia diagnosed? There is no simple test for spasmodic dysphonia. 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 a team approach and includes: a speech-language pathologist (SLP) 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. What treatments are available for spasmodic dysphonia? 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 are frequently recommended and peformed by doctors. 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 an SLP may also be recommended following injections to optimize voice production. Find out more information about Botox , including some recent warnings about its use. 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. What other organizations have information about spasmodic dysphonia? This list is not exhaustive, and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA. Dystonia Medical Research Foundation What causes spasmodic dysphonia? Symptoms come from more than one source. Some people appear to have nervous system changes that produce an organic tremor of the vocal cords. 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.

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. How effective are treatments for spasmodic dysphonia? Speech-language pathology services alone are most helpful when symptoms are mild. Techniques such as relaxation, breath control, maintaining a steady flow of air from the lungs during voice production, and pitch and loudness modifications can help improve the person's voice. Recent studies have shown that cutting of the recurrent laryngeal nerve to paralyze one vocal cord appeared to reduce the force of vocal cord closure. There was a return of voice symptoms within 6 months to 3 years of surgery in almost two thirds of these patients. Many patients were worse than before. Speech-language pathology treatment was often recommended after surgery. ASHA has written a treatment efficacy summary on voice disorders [PDF] that describes evidence about how well treatment works. This summary is useful not only to individuals with voice disorders and their caregivers but also to insurance companies considering payment for much needed services for voice disorders. What do SLPs do when working with individuals with spasmodic dysphonia?

The Preferred Practice Patterns for the Profession of Speech-Language Pathology outline the common practices followed by SLPs when engaging in various aspects of the profession. The Preferred Practice Patterns for voice assessment and intervention are outlined in sections 34 and 35. National Spasmodic Dysphonia Association: Home Page National Spasmodic Dysphonia Association Members What is Spasmodic Dysphonia? Spasmodic dysphonia (SD), a focal form of dystonia, is a neurological voice disorder that involves "spasms" of the vocal cords causing interruptions of speech and affecting the voice quality. SD can cause the voice to break up or to have a tight, strained, or strangled quality. Quick Links Sign up for Email News NSDA news Join us for the 2017 Symposium in Nashville, TN The National Spasmodic Dysphonia Association invites you to attend our Symposium on Saturday, May 6, 2017, at the Embassy Suites by Hilton Nashville Airport in Nashville, TN. Join us for fellowship, education, and fun. The event will host some of the leading experts in the field of spasmodic dysphonia while providing the opportunity to meet others who share a similar experience.

More... Hear of the some of the leading experts in the field of spasmodic dysphonia. Confirmed speakers include (more to be added): Vanderbilt Voice Center - Gaelyn Garrett, M.D. and David Francis, M.D. UCLA, Los Angeles, CA - Gerald Berke, M.D., NSDA Scientific Director University of Minnesota, MN - Teresa Kimberley, PT, Ph.D., NSDA Grant Recipient Click here for more details! You Are The Expert: SD and Social Situations With the holidays approaching, we asked "How do you handle social situations, like family gatherings or parties?" We received some great responsed and complied them in a list. Click here to download it . We hope you find it helpful! This is the first version and we will keep adding to it. More... If you have additional suggestions, please let us know, because all of you are the experts! The Complexities of Spasmodic Dysphonia brought to light in the Wall Street Journal Article A recent article in the Wall Street Journal entitled, "The Brain Wiring Behind a Frustrating Speech Disorder," is helping to raise awareness about spasmodic dysphonia. More...

With the focus on the complexity of understanding SD, it features researchers who are approaching SD in different ways, including Dr. Kristina Simonyan. Also included is the personal side of SD. Tommy Johnson, who has lived with SD for over three decades talks about the challenges of SD and how he is contributing to the research. Click here to read the article online or download a PDF . We encourage you to share the article to help continue to raise awareness! Midwest Educational Conference Recap The National Spasmodic Dysphonia Association hosted its 2016 Midwest Conference on April 30, 2016 in Des Plaines, IL. Click here to a read of summary of the Conference. Also, recordings of some of the session are available on YouTube by clicking here More... On Friday evening, prior to the conference, a Welcome Reception provided the opportunity for fellowship and support, when people shared their personal experiences. President Charlie Reavisstarted the program on Saturday morning with an overview of the mission of the NSDA. The first sessions of the Conference focused on the medical aspects of spasmodic dysphonia with Dr. Robert Bastian presenting an overview of the disorder, and Dr. Gerald Berke discussing treatment options.

Several researchers, some who are funded by the NSDA, including Drs. Kristina Simonyan, Mo Chen, Michael Hammer, and Rita Patel, shared their different approaches to better understanding spasmodic dysphonia, After lunch, Dr. Laura Froeschke talked about how spasmodic dysphonia can affect your identity, and Speech Language Pathologists Jan Potter Reed and Brienne Ruel provided voice therapy tips and recommendations in break-out sessions. One person commented, "It was great meeting so many people who understood what I was going through and not being embarrassed to speak," and another said "What I enjoyed was the variability of approaches to SD research, various treatment options, and integrating the problems of SD in our lives." Our thanks to all who attended! Also look for the NSDA on: Listen to Voice Samples Hear audio clips of spasmodic dysphonia, and read about symptoms and treatments using the interactive device below. Charlie Stephie Meet Our Members The NSDA is a grassroots organization working to improve the lives of people with spasmodic dysphonia. This shines through with our members who share their own experiences and knowledge to empower others with SD. More...

Our Vision The vision of the NSDA is to ensure the ongoing viability of the organization that will continue to lead the effort to eradicate spasmodic dysphonia. NSDA's Core Values Our Mission The mission of the NSDA is to advance medical research into the causes of and treatments for spasmodic dysphonia, promote physician and public awareness of the disorder, and provide support to those affected by spasmodic dysphonia. 300 Park Boulevard, Suite 335 Itasca, Illinois 60143 © 2017 National Spasmodic Dysphonia Association. Site design by Studio Prima. Erik New York, NY I had adductor spasmodic dysphonia. Yes, “had” past tense. While I know there is no cure yet for SD, the treatment I underwent has eliminated my symptoms. For me, this is as good as a cure. SD is an extremely annoying condition, but it’s not life threatening, and thanks to the efforts of many, there are now good options to treat it. Be open about your voice affliction, keep a good sense of humor about it, then get it treated and get your life back!

Previous | Next I was self-diagnosed in 1992, about 2 years after onset and after having seen a half dozen “specialists.” In those pre-Google days, I found an article in the periodicals section at the library. Mid-way through the first paragraph, I knew what I had. The article’s author, Dr. Mitchell Brin, later confirmed this. My symptoms were pretty characteristic for ADSD: intermittent voice breaks. Some days and some situations were better than others. My symptoms were described as mild or mild to moderate. I tried Botox initially, with mixed results. In 2011, I underwent the Selective Laryngeal Adductor Denervation-Rennervation (SLAD-R) by Dr. Berke at UCLA Medical Center. The recovery from that was long, but the results were outstanding, effectively ridding me of this horrible condition. I have not required any further treatment. Read my full story at The NSDA assisted with support groups in the early days. The annual meetings are a great source of information exchange. By sharing positive stories like mine, the NSDA offers great hope for others.

Pat Glendale, CA I have adductor spasmodic dysphonia with essential tremor. Remember, your voice is a vital life function but there are things that are so much worse and we should not let our voices define who we are. Rise above it when others around you can't. I was diagnosed at Eastern Washington University when my special education director suggested it. He had been a speech language pathologist. The diagnosis was confirmed by Dr. Berke at UCLA. I had been undiagnosed for about 20 years. My symptoms were strangled, hesitant speech that could not be controlled. I had botulinum toxin injections for seven years and then successful SLAD-R surgery with Dr. Berke at UCLA. The NSDA has always been there for me with information and support. I was no longer alone and understood that I was not my voice. Tom Fort Meyers, FL I have adductor spasmodic dysphonia. Living with SD requires adjustment to what is, but why not use the necessary changes we need to make to live even better than before? I also agree with those who do not let SD change who they are inside. I was diagnosed with moderate adductor spasmodic dysphonia.

I have a strained, strangled voice with a loss of fluency. My treatment includes botulinum toxin injections, educating those around me about the disorder, and developing a life and lifestyle where I can thrive given the reality of the disorder. The NSDA shares bountiful information, and perhaps as or more importantly supports research and advocacy to alert medical professionals and others to the disorder. Emily After reading an article in the newspaper that sounded similar to the symptoms I was experiencing, I contacted the doctor from the article. He listened to me speak and then ran some tests. He confirmed I had abductor spasmodic dysphonia. My symptoms include breathiness...words evaporated with lots of air coming out instead. I receive botulinum toxin injections. The NSDA’s social support through the Bulletin Board gave me comfort that I was not alone, that others understood and experienced all I had encountered including the myriad of emotions I had about my voice The SD Bulletin Board lets you post questions and thoughts and receive helpful responses from others in the same situation. Like on-line botulinum toxin injection jabs, it’s a greater booster and lift for your low days. Wendy I was diagnosed was in 2005 by Dr.

John Schweinfurth at the University of Mississippi Medical Center in Jackson, Mississippi. My symptoms are breathiness, exhaustion and lack of ease in speaking, and voice breaks. My treatment includes a year of speech therapy at the University of Mississipppi Speech and Hearing Center, including "Lee Silverman Voice Treatment." Also a weekly massage, Alexander Technique, and voice lessons from an opera singer and an actress. The NSDA made having spasmodic dysphonia more like being in a fun club than being isolated by an unusual condition. First I found the website, then became support group leader and then participated in the national symposium. Cathy Darien, IL I have had adductor spasmodic dysphonia since 1986. Spasmodic dysphonia is very challenging to deal with, but a good positive mental attitude and a big dose of personal self-confidence will assure us that we have something worthwhile to offer the world. We are more than our voice! Previous | Next It took almost two years before I was diagnosed with spasmodic dysphonia in 1988.

Words such as stress, allergies, vocal cord misuse, psychosomatic, and severe nervous tension were used on a regular basis by medical personnel. My vocal cords felt very tight, like I was being strangled. I was unable to complete a sentence without choking up between words and it was very exhausting. I have had over 50 botulinum toxin injections. I also do meditation, journaling and exercise to relieve the tension. The NSDA has been an invaluable asset to those of us with SD. Education, awareness, research and support have made a huge difference in how we are equipped to deal with our debilitation disorder Mary Charlotte, NC I have abductor spasmodic dysphonia. The NSDA was there for me when I was first diagnosed with SD. It is a joy and a privilege to be there for others affected by SD. A speech-language pathologist thought I needed to see an otolaryngologist after working with me on voice therapy for 18 months. The first ENT I saw thought that I had SD but preferred that I see a specialist who diagnosed me.

My symptoms include Breathiness, spasms and difficulty with saying initial consonants, particularly “h” In the past 21 years since I was diagnosed with SD, I have had a total of nine Botox injections. I think that only 1 or 2 of them were effective. I have undergone voice therapy twice during this period. Far and away, the NSDA has played the most critical part in helping me come to terms with SD. I have been blessed by being involved with the NSDA community. They continue to teach me many life lessons. Mel The Villages, FL I was diagnosed with adductor spasmodic dysphonia in 1998. In 2007, my diagnosis was revised to a mild case of AD/SD along with the strong case of muscle tension dysphonia (MTD). Previous | Next While my initial adductor spasmodic dysphonia diagnosis came on my first visit to an ENT at a university medical hospital, it was eight years before my true diagnosis was arrived upon. I feel this reflects an improvement in the ability of ENTs to better recognize MTD and how it can be distinguished from adductor spasmodic dysphonia.

My symptoms started with laryngitis and quickly developed into a difficulty of getting words out. It was a strained, strangled voice but I did not have word breaks like many others with SD have. I was on a botulinum toxin regime for three years but it was overall ineffective. I tried a wide range of prescription drugs and speech therapy. Speech therapy was effective in removing my poor speech habits and dealing with my MTD element. NSDA gave me an invaluable common link with other SD people through the world. As an NSDA leader, helping others yielded an unexpected cathartic experience, a gained sense of empowerment over SD. Email and the Internet have been a powerful SD coping force in my life. The personal interaction with people at various NSDA symposiums and meetings help tie it all together. I've always had confidence in my abilities and never let SD define me as a person. Carol Forest, VA I have adductor spasmodic dysphonia. Meeting other SD patients has been encouraging. My support group has helped me gain the confidence I need to go forth boldly, determined to help others listen beyond the sound of my voice. Previous | Next I was misdiagnosed for six years.

My voice deterioration was attributed to allergies, reflux, and stress. My voice sounds strained and strangled and has breaks in the sound. I have the sensation of someone choking me as I try to force words out. I receive botulinum toxin injections into both vocal chords approximately every three months. I also incorporate techniques learned in speech therapy to help with spasms. The NSDA has provided me with the resources to become better educated about my disorder. This has empowered me to make informed decisions about my care and to become an advocate for the cause. Spasmodic Dysphonia | NIDCD Spasmodic Dysphonia Where can I get more information? What is spasmodic dysphonia? Spasmodic dysphonia is a neurological disorder affecting the voice muscles in the larynx, or voice box. When we speak, air from the lungs is pushed between two elastic structures—called vocal folds or vocal cords —with sufficient pressure to cause them to vibrate, producing voice (see figure). In spasmodic dysphonia, the muscles inside the vocal folds experience sudden involuntary movements—called spasms—which interfere with the ability of the folds to vibrate and produce voice.

Spasmodic dysphonia causes voice breaks and can give the voice a tight, strained quality. People with spasmodic dysphonia may have occasional breaks in their voice that occur once every few sentences. Usually, however, the disorder is more severe and spasms may occur on every other word, making a person's speech very difficult for others to understand. At first, symptoms may be mild and occur only occasionally, but they may worsen and become more frequent over time. Spasmodic dysphonia is a chronic condition that continues throughout a person's life. Spasmodic dysphonia can affect anyone. It is a rare disorder, occurring in roughly one to four people per 100,000 people. The first signs of spasmodic dysphonia are found most often in people between 30 and 50 years of age. It affects women more than men. What are the types of spasmodic dysphonia? Adductor spasmodic dysphonia is the most common form of spasmodic dysphonia. It is characterized by spasms that cause the vocal folds to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce sounds.

Words are often cut off or are difficult to start because of muscle spasms. Therefore, speech may be choppy. The voice of someone with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. The spasms are usually absent—and the voice sounds normal—while laughing, crying, or shouting. Stress often makes the muscle spasms more severe. Abductor spasmodic dysphonia is characterized by spasms that cause the vocal folds to open. The vocal folds cannot vibrate when they are open too far. The open position also allows air to escape from the lungs during speech. As a result, the voice often sounds weak and breathy. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing, crying, or shouting. Mixed spasmodic dysphonia, a combination of the above two types, is very rare. Because both the muscles that open and the muscles that close the vocal folds are not working properly, it has features of both adductor and abductor spasmodic dysphonia. What causes spasmodic dysphonia? The cause of spasmodic dysphonia is unknown.

Because the voice can sound normal or near normal at times, spasmodic dysphonia was once thought to be psychogenic, or originating in a person's mind, rather than from a physical cause. In rare cases, psychogenic forms of spasmodic dysphonia do exist; however, in most instances, the muscle spasms are caused by abnormalities in the central nervous system (the brain). A disorder that involves involuntary muscle contractions is also called a dystonia; therefore, another name for spasmodic dysphonia is laryngeal dystonia. Spasmodic dysphonia is considered a form of focal dystonia, a neurological disorder that affects muscle tone in one part of the body. Writer's cramp is another type of focal dystonia. Other dystonias can affect multiple regions of the body or the entire body. Spasmodic dysphonia may co-occur with other dystonias that cause involuntary and repetitious movement of such muscles as the eyes; face, body, arms, and legs; jaws, lips, and tongue; or neck. Spasmodic dysphonia is thought to be caused by abnormal functioning in an area of the brain called the basal ganglia.

The basal ganglia consist of several clusters of nerve cells deep inside the brain. They help coordinate movements of the muscles throughout the body. Recent research has found abnormalities in other regions of the brain, including the brainstem, the stalk-like part of the brain that connects to the spinal cord. Symptoms of spasmodic dysphonia generally develop gradually and with no obvious explanation. Some people with spasmodic dysphonia also have vocal tremor, a shaking of the larynx and vocal folds that causes the voice to shake. Although the risk factors for spasmodic dysphonia have not been identified, the voice symptoms can begin following an upper respiratory infection, injury to the larynx, voice overuse, or stress. In some cases, spasmodic dysphonia may run in families. Although 14 genes have been recently associated with various dystonias, only mutations in one gene, named THAP1, have been associated with forms of whole body dystonia that begin in childhood and that appear with spasmodic dysphonia. This genetic defect does not seem to be associated with the more usual form of focal spasmodic dysphonia that begins in adults, however. How is spasmodic dysphonia diagnosed?

Diagnosis of spasmodic dysphonia is sometimes difficult because individuals with spasmodic dysphonia often have symptoms similar to other voice disorders. The diagnosis of spasmodic dysphonia usually is made following careful examination by a team that includes an otolaryngologist, a doctor who specializes in diseases of the ear, nose, throat, head, and neck; a speech-language pathologist, a health professional trained to evaluate and treat speech, language, and voice disorders; and a neurologist, a doctor who specializes in nervous system disorders. The otolaryngologist examines the vocal folds for other possible causes of the voice disorder. A small lighted tube is passed through the nose and into the back of the throat—a procedure called fiberoptic nasolaryngoscopy—allowing the otolaryngologist to evaluate vocal fold structure and movement during speech and other activities. The speech-language pathologist evaluates the types of voice symptoms to see if they are characteristic of spasmodic dysphonia or other voice disorders and voice quality. The neurologist evaluates the patient for signs of other muscle movement disorders. What treatment is available for spasmodic dysphonia?

There is currently no cure for spasmodic dysphonia; therefore, treatment can only help reduce its symptoms. The most common treatment for spasmodic dysphonia is the injection of very small amounts of botulinum toxin directly into the affected muscles of the larynx. Botulinum toxin is produced by Clostridium botulinum, the same bacterium that occurs in improperly canned foods and honey. The toxin weakens muscles by blocking the nerve impulse to the muscle. Botulinum toxin injections generally improve the voice for a period of three to four months, after which the voice symptoms gradually return. Reinjections are necessary to maintain a good speaking voice. Initial side effects, including a temporary weak, breathy voice and occasional swallowing difficulties, usually subside after a few days to a few weeks. Botulinum toxin will relieve symptoms of most cases of adductor spasmodic dysphonia and is helpful in many cases of abductor spasmodic dysphonia. Behavioral therapy (voice therapy) is another form of treatment that may work to reduce symptoms in mild cases. Other people may benefit from psychological counseling to help them accept and live with their voice problem.

In some cases, augmentative and alternative devices can help people with spasmodic dysphonia to communicate more easily. For example, some devices can help amplify a person's voice in person or over the phone. Special software can be added to a computer or handheld device such as a personal digital assistant (PDA) or cell phone to translate text into synthetic speech. When more conventional measures have failed, surgery on the larynx may be performed. Long-term benefits and effects of this procedure are unknown. What research is being done on spasmodic dysphonia? Scientists and clinicians are working to understand the causes of spasmodic dysphonia as well as the underlying manner in which the disorder develops. Brain imaging studies enable researchers to better identify possible differences between people with spasmodic dysphonia and healthy volunteers as well as to observe how spasmodic dysphonia compares with other dystonias. Although an animal model is not currently available for the study of spasmodic dysphonia, several have been developed for the study of other forms of dystonia. If a suitable animal model is identified, researchers will have a new tool to explore the underlying cause of spasmodic dysphonia and to test new treatments.

Genetic studies of spasmodic dysphonia are currently ongoing. However, the disorder is rare, and it is difficult for researchers to locate large families with a history of spasmodic dysphonia alone. However, new technologies that rapidly pinpoint small differences in a person's DNA, called single nucleotide polymorphisms, or SNPs, are becoming available that will enable clinician-scientists to study unrelated patients with spasmodic dysphonia. This development will make it easier to determine whether a gene is involved and possible environmental causes of the disorder. At a 2005 workshop co-sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD), participants emphasized the need for a standardized three-step procedure in diagnosing spasmodic dysphonia, including: a questionnaire on which a patient reports a possible case of spasmodic dysphonia, a clinical examination to identify a probable case of spasmodic dysphonia, and a fiberoptic nasolaryngoscopy to confirm a case of spasmodic dysphonia.

In 2009, a five-year multicenter trial was funded by the National Institutes of Health Office of Rare Diseases Research and the National Institute of Neurological Disorders and Stroke that will determine the accuracy and reliability of this method for diagnosing spasmodic dysphonia. Where can I get more information? The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. Please see the list of organizations at Use the following keywords to help you search for organizations that can answer questions and provide printed or electronic information on spasmodic dysphonia: Functional Dysphonia | Michigan Medicine Functional Dysphonia Functional Dysphonia Dysphonia (diss-PHONE-nee-yah) is the medical term for disorders of the voice. Functional dysphonia is poor voice quality without any obvious anatomical, neurological or other organic difficulties affecting the larynx or voice box. It is also referred to as functional voice difficulty. There are two types of functional dysphonia: Hypofunctional dysphonia — Results from an incomplete closure of the vocal cords or folds.

Hyperfunctional dysphonia — Results from overuse of the laryngeal muscles and, occasionally, use of the false vocal folds (the upper two vocal folds that are not involved in vocalization). Functional dysphonia is more common in women over age 40. Causes Functional dysphonia is occasionally associated with viral illness (including measles and mumps) and major life stress. Signs or Symptoms Typical symptoms of functional dysphonia include: Breathy, hoarse or rough voice Voice instability Voice fatigue Diagnosis The University of Michigan Vocal Health Center team will ask you about your symptoms and medical history, and then do a thorough head and neck examination. During this process, we will also assess your vocal quality, vocal efficiency and speaking technique. To make sure that there are no structural problems or disease, we may do a laryngoscopy procedure. The physician uses this procedure to get a clear and complete view of the vocal folds. Treatment Overall, functional dysphonia is very treatable.

At the University of Michigan Vocal Health Center, we offer a variety of treatments for functional dysphonia, including: Voice therapy Laryngeal massage, which lowers the larynx and relaxes tense muscles Make an Appointment Schedule an appointment by calling us at (734) 936-8051. News Dysphonia - Medical Conditions - Rush University Medical Center Rush University Medical Center It's How Medicine Should Be ® Search by Topic or Doctor's Name View by Specialty Advanced Doctor Search > Doctors at Rush Focus on You I want to partner with patients. I want it to be a very open, interactive relationship, and include them in decision-making. Search by Clinical Trial Area Moving Medicine Forward With dozens of clinical trials open at any given time, doctors at Rush aim to give today’s patients new options. And improve the lives of future patients all over the world. Community Service All Hospitals Are Not Created Equal Before choosing a hospital, you might want to know how it compares to others. Rush invites you to take a look at the data that show how the Medical Center stacks up. Video Library Health News and Advice to Fit Your Life The choices you make each day can have a huge effect on your health.

Rush offers a wealth of resources to help you make good ones. Contact Media Relations Participants Needed for MIND Diet Study Can a specific diet prevent the development of Alzheimer’s? A new study by researchers at Rush aims to find out. Targeting Cancer With Laser Precision Photoimmunotherapy is an experimental technique that combines the immune system’s ability to target cancer cells precisely with laser energy’s ability to destroy them. Inna Husain, MD Dysphonia is a disorder of the voice, often caused by abnormalities that affect vocal cord vibration. It hampers your ability to speak easily and clearly. Dysphonia can significantly impact your day-to-day life and even prevent you from doing your job. If you have been diagnosed with dysphonia, or are having trouble speaking and don't know why, experts at Rush's Voice, Airway and Swallowing Program are here to help you. Dysphonia symptoms People with dysphonia have difficulty using their voices for speaking. They may not experience the same difficulties all of the time. Symptoms can be recurrent and may occur with singing or prolonged speaking.

Symptoms may include the following: Hoarse voice Tight or strained voice, as if requiring extra effort Voice that wavers or is choppy Symptoms of dysphonia may come on suddenly or gradually. You may begin experiencing symptoms after an injury or upper respiratory infection. Dysphonia: what you should know There are several conditions that affect the voice, including the following: Muscle tension dysphonia (MTD): One of the most common voice disorders, MTD is due to an abnormal pattern of muscle activation. Vocal cord paralysis: There are many causes for this paralysis, including nerve damage from surgery, infection or certain cancers. Phonotraumatic lesions: Singers and others who use their voices professionally may develop cysts, polyps or nodules on their vocal cords. Precancerous lesions: Removing precancerous lesions on the vocal cords can help reduce the risk of cancer. Recurrent respiratory papillomatosis (RRP): A rare disease where tumors grow in the respiratory tract, RRP is called laryngeal papillomatosis when it affects the voice box.

Paradoxical vocal cord motion (PVCM): Also called vocal cord dysfunction, PVCM is often misdiagnosed as asthma , although it can also be seen in patients with asthma. Neurological diseases: Voice changes are commonly associated with Parkinson's disease as well as other neurological conditions, such as dystonias , including spasmodic dysphonia. How can I get help for dysphonia? Call your primary care physician if you experience any problems with your voice. If your doctor suspects you may have dysphonia or another disorder affecting your voice, he or she may refer you to a voice specialist, like the experts with Rush's Voice, Airway and Swallowing Program . Care for dysphonia at Rush At Rush, you'll find a program specifically designed to treat conditions that affect the voice, like dysphonia. Rush's Voice, Airway and Swallowing Program provides comprehensive care from a team of experts led by a specialist who treats only voice and airway disorders. Diagnosis A Rush specialist will examine your vocal cords and larynx with stroboscopy, an endoscope with a special light to look at how your vocal cords vibrate.

If needed, a voice therapist may be consulted to help develop your treatment plan. Treatment At Rush, we personalize treatment to your specific needs, with the goal of helping you speak more clearly and easily. Your treatment plan may involve one or more of the following: Voice therapy to improve vocal hygiene and vocal cord function. Medications to manage conditions that cause inflammation of the vocal folds, such as anti-reflux medication for laryngopharyngeal reflux (LPR) or neuromodulators for laryngeal sensitivity or paradoxical vocal fold motion. Botulinum toxin injections are the standard for management of dystonias, including spasmodic dysphonia. The botulinum is usually given every three to four months to the muscles surrounding the vocal cords to relieve the spasms. Why choose Rush for dysphonia care Expertise you can trust: The experts at Rush's Voice, Airway and Swallowing Program provide sophisticated diagnostic capabilities and comprehensive treatment options for dysphonia and other voice disorders, as well as issues with breathing and swallowing. Comprehensive ENT care: The Voice, Airway and Swallowing Program is part of the Department of Otorhinolaryngology at Rush.

Our ENT specialists offer advanced solutions and compassionate, coordinated care for a full range of ear, nose and throat conditions — from the common to the complex — in children and adults. Departments and programs that treat this condition Definition of Dysphonia Definition of Dysphonia Dysphonia: An impairment of the voice. Difficulty in speaking. Hoarseness caused by a virus is a common form of dysphonia. Last Editorial Review: 5/13/2016 NSDA: Spasmodic Dysphonia: Symptoms Spasmodic Dysphonia Sign up for Email News Symptoms Play People with SD initially notice either a gradual or sudden onset of difficulty in speaking. They may hear breaks in their voices during production of certain words or speech sounds, breathy-sounding pauses on certain words or sounds, or a tremulous shaking of the voice. They may feel that talking requires more effort than before. Often people say that their voices sound as if they “have a cold or laryngitis.” The symptoms of SD can vary from mild to severe. A person's voice can sound strained, tight, strangled, breathy, or whispery.

The spasms often interrupt the sound, squeezing their voice to nothing or dropping it to a whisper. Stress does not cause SD, but it can worsen the spasms. Adductor Spasmodic Dysphonia SD is generally catergorized into two primary forms: adductor spasmodic dysphonia (AdSD) and abductor spasmodic dysphonia (AbSD). Adductor SD, the most common form, affects approximately 80–90% of people with SD. In this type, spasms, usually in the thyroarytenoid muscle (TA), force the vocal folds together in adduction, or closing. AdSD may also affect the lateral cricoarytenoid muscle (LCA) or interarytenoid (IA). These spasms occur particularly on “voiced” speech sounds. Examples of “voiced” sounds that cause problems for people with adductor SD include the vowel sounds in the words "eat," "back," "in," "I," "olives," or "nest." If the voice cuts out, or breaks when the voiced sound is at the beginning of the word, as in “eels,” the speaker often strains over the spasm to get the word started.

If the troubling vowel occurs in the middle of the word, the voice often breaks the word in two. For example, the word “lawn” would come out as “la---awn.” When the voiced vowel is at the end of the word, such as “pleasingly,” the word terminates earlier than it should, causing the speaker to sound as if he or she is swallowing words. The speaker usually has no effort or disruption with the non-voiced vowels and unvoiced consonants. However, since most words and sentences contain voiced sounds, an adductor voice can be very hard to understand as the spasms continuously interrupt the flow of speech. In very severe cases of AD, the speaker may need to use extreme effort to produce any voice at all since vowels occur frequently in speech. People with AdSD often complain of having to struggle to speak. Abductor Spasmodic Dysphonia AbSD, a less common form, occurs in approximately 10–20 percent of cases and results from spasms when the posterior cricoarytenoid muscles (PCA) abducts, or opens, the vocal folds.

AbSD causes problems with the production of “voiceless” speech sounds, which normally sound “airy” or “breathy” when produced. Examples of “voiceless” speech sounds are: “f” as in funny, “k” as in kite or cat, “t” as in top “h” as in hello, “th” as in thank you, and “s” as in master In AbSD, the spasms in the abductor muscles cause the vocal folds to remain open for a longer duration than should normally occur on these sound combinations. This results in the voice taking longer to complete the voiceless sounds, which makes the speaker sound “breathy.” For example, a person with AbSD might produce the word “he” as “h……….he.” The symptoms of AbSD can occur on any voiceless sound at the beginning, middle, or end of the word. As with AdSD, the symptoms in AbSD can range from mild to severe. Significant overall breathiness or a whispered voice quality may occur in people with a very severe form of the disorder where breaks occur on every voiceless consonant.

Because people with AbSD expend too much air as they produce sound, they often describe feeling winded or out-of-breath during speaking. Subtypes of Spasmodic Dysphonia While most people with spasmodic dysphonia fall into these two categories, researchers have identified several subtypes. A person may have a mixed form with symptoms of both AdSD and AbSD. Some people with SD also have a tremor in their voice. Typically, tremor affects muscle groups outside of the larynx and can cause the voice to sound “shaky” or “quivery.” Like adductor and abductor spasmodic dysphonia, the symptoms of vocal tremor can range from mild (infrequent, periodic tremor) to severe (affecting all voicing and singing). A very severe tremor with significant shaking can even cause the voice to cut out, sounding similar to the voice breaks in AdSD. In addition, sometimes treatment of the SD symptoms reveals a co-existing underlying tremor. Muscle Tension Dysphonia SD may also be accompanied by or misdiagnosed as muscle tension dysphonia (MTD), which is sometimes also referred to as a “hyperfunctional” voice.

Although the MTD voice sounds tight or strained and sometimes similar to AdSD, MTD is considered a functional condition rather than a neurological one. MTD occurs when the speaker exerts too much pressure or effort on the laryngeal muscles. In some cases, people with AdSD may try to hold their vocal folds tighter in an attempt to control them. This compensatory mechanism can result in the person developing a variant of MTD on top of the SD. Examples of Symptom Provoking Sentences During an evaluation by a healthcare professional, a specific series of voicing and speaking tasks may be used to determine the type of SD. People with AdSD will have more difficult with sentences with voiced sound such as these: Albert eats eggs every Easter We mow our lawn all year long Early one morning a man and a woman were ambling along a one mile lane Whereas people with AbSD will find these sentences with voiceless sounds more challenging: Harry hit the hammer hard She sells seashells by the seashore The puppy bit the tape Other parts of the evaluation may include reciting numbers, singing, laughing and shouting. Spasmodic Dysphonia Causes & Treatment | Cleveland Clinic Share Facebook Twitter Linkedin Email Print What is spasmodic dysphonia?

Spasmodic dysphonia is a neurological disorder affecting the voice muscles in the larynx, or voice box. When we speak, air from the lungs is pushed between two elastic structures—called vocal folds or vocal cords—with sufficient pressure to cause them to vibrate, producing voice (see figure). In spasmodic dysphonia, the muscles inside the vocal folds experience sudden involuntary movements—called spasms—which interfere with the ability of the folds to vibrate and produce voice. Spasmodic dysphonia causes voice breaks and can give the voice a tight, strained quality. People with spasmodic dysphonia may have occasional breaks in their voice that occur once every few sentences. Usually, however, the disorder is more severe and spasms may occur on every other word, making a person's speech very difficult for others to understand. At first, symptoms may be mild and occur only occasionally, but they may worsen and become more frequent over time. Spasmodic dysphonia is a chronic condition that continues throughout a person's life. Spasmodic dysphonia can affect anyone. It is a rare disorder, occurring in roughly one to four people per 100,000 people.

The first signs of spasmodic dysphonia are found most often in people between 30 and 50 years of age. It affects women more than men. What are the types of spasmodic dysphonia? Adductor spasmodic dysphonia is the most common form of spasmodic dysphonia. It is characterized by spasms that cause the vocal folds to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce sounds. Words are often cut off or are difficult to start because of muscle spasms. Therefore, speech may be choppy. The voice of someone with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. The spasms are usually absent—and the voice sounds normal—while laughing, crying, or shouting. Stress often makes the muscle spasms more severe. Abductor spasmodic dysphonia is characterized by spasms that cause the vocal folds to open. The vocal folds cannot vibrate when they are open too far. The open position also allows air to escape from the lungs during speech. As a result, the voice often sounds weak and breathy.

As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing, crying, or shouting. Mixed spasmodic dysphonia, a combination of the above two types, is very rare. Because both the muscles that open and the muscles that close the vocal folds are not working properly, it has features of both adductor and abductor spasmodic dysphonia. What causes spasmodic dysphonia? The cause of spasmodic dysphonia is unknown. Because the voice can sound normal or near normal at times, spasmodic dysphonia was once thought to be psychogenic, or originating in a person's mind, rather than from a physical cause. In rare cases, psychogenic forms of spasmodic dysphonia do exist; however, in most instances, the muscle spasms are caused by abnormalities in the central nervous system (the brain). A disorder that involves involuntary muscle contractions is also called a dystonia ; therefore, another name for spasmodic dysphonia is laryngeal dystonia. Spasmodic dysphonia is considered a form of focal dystonia, a neurological disorder that affects muscle tone in one part of the body.

Writer's cramp is another type of focal dystonia. Other dystonias can affect multiple regions of the body or the entire body. Spasmodic dysphonia may co-occur with other dystonias that cause involuntary and repetitious movement of such muscles as the eyes; face, body, arms, and legs; jaws, lips, and tongue; or neck. Spasmodic dysphonia is thought to be caused by abnormal functioning in an area of the brain called the basal ganglia. The basal ganglia consist of several clusters of nerve cells deep inside the brain. They help coordinate movements of the muscles throughout the body. Recent research has found abnormalities in other regions of the brain, including the brainstem, the stalk-like part of the brain that connects to the spinal cord. Symptoms of spasmodic dysphonia generally develop gradually and with no obvious explanation. Some people with spasmodic dysphonia also have vocal tremor, a shaking of the larynx and vocal folds that causes the voice to shake. Although the risk factors for spasmodic dysphonia have not been identified, the voice symptoms can begin following an upper respiratory infection, injury to the larynx, voice overuse, or stress.

In some cases, spasmodic dysphonia may run in families. Although 14 genes have been recently associated with various dystonias, only mutations in one gene, named THAP1, have been associated with forms of whole body dystonia that begin in childhood and that appear with spasmodic dysphonia. This genetic defect does not seem to be associated with the more usual form of focal spasmodic dysphonia that begins in adults, however. How is spasmodic dysphonia diagnosed? Diagnosis of spasmodic dysphonia is sometimes difficult because individuals with spasmodic dysphonia often have symptoms similar to other voice disorders. The diagnosis of spasmodic dysphonia usually is made following careful examination by a team that includes an otolaryngologist, a doctor who specializes in diseases of the ear, nose, throat, head, and neck; a speech-language pathologist, a health professional trained to evaluate and treat speech, language, and voice disorders; and a neurologist, a doctor who specializes in nervous system disorders. The otolaryngologist examines the vocal folds for other possible causes of the voice disorder.

A small lighted tube is passed through the nose and into the back of the throat—a procedure called fiberoptic nasolaryngoscopy—allowing the otolaryngologist to evaluate vocal fold structure and movement during speech and other activities. The speech-language pathologist evaluates the types of voice symptoms to see if they are characteristic of spasmodic dysphonia or other voice disorders and voice quality. The neurologist evaluates the patient for signs of other muscle movement disorders. What treatment is available for spasmodic dysphonia? There is currently no cure for spasmodic dysphonia; therefore, treatment can only help reduce its symptoms. The most common treatment for spasmodic dysphonia is the injection of very small amounts of botulinum toxin directly into the affected muscles of the larynx. Botulinum toxin is produced by Clostridium botulinum, the same bacterium that occurs in improperly canned foods and honey. The toxin weakens muscles by blocking the nerve impulse to the muscle. Botulinum toxin injections generally improve the voice for a period of three to four months, after which the voice symptoms gradually return. Reinjections are necessary to maintain a good speaking voice.

Initial side effects, including a temporary weak, breathy voice and occasional swallowing difficulties, usually subside after a few days to a few weeks. Botulinum toxin will relieve symptoms of most cases of adductor spasmodic dysphonia and is helpful in many cases of abductor spasmodic dysphonia. Behavioral therapy (voice therapy) is another form of treatment that may work to reduce symptoms in mild cases. Other people may benefit from psychological counseling to help them accept and live with their voice problem. In some cases, augmentative and alternative devices can help people with spasmodic dysphonia to communicate more easily. For example, some devices can help amplify a person's voice in person or over the phone. Special software can be added to a computer or handheld device such as a personal digital assistant (PDA) or cell phone to translate text into synthetic speech. When more conventional measures have failed, surgery on the larynx may be performed. Long-term benefits and effects of this procedure are unknown. What research is being done on spasmodic dysphonia? Scientists and clinicians are working to understand the causes of spasmodic dysphonia as well as the underlying manner in which the disorder develops.

Brain imaging studies enable researchers to better identify possible differences between people with spasmodic dysphonia and healthy volunteers as well as to observe how spasmodic dysphonia compares with other dystonias. Although an animal model is not currently available for the study of spasmodic dysphonia, several have been developed for the study of other forms of dystonia. If a suitable animal model is identified, researchers will have a new tool to explore the underlying cause of spasmodic dysphonia and to test new treatments. Genetic studies of spasmodic dysphonia are currently ongoing. However, the disorder is rare, and it is difficult for researchers to locate large families with a history of spasmodic dysphonia alone. However, new technologies that rapidly pinpoint small differences in a person's DNA, called single nucleotide polymorphisms, or SNPs, are becoming available that will enable clinician-scientists to study unrelated patients with spasmodic dysphonia. This development will make it easier to determine whether a gene is involved and possible environmental causes of the disorder.

At a 2005 workshop co-sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD), participants emphasized the need for a standardized three-step procedure in diagnosing spasmodic dysphonia, including: a questionnaire on which a patient reports a possible case of spasmodic dysphonia, a clinical examination to identify a probable case of spasmodic dysphonia, and a fiberoptic nasolaryngoscopy to confirm a case of spasmodic dysphonia. In 2009, a five-year multicenter trial was funded by the National Institutes of Health Office of Rare Diseases Research and the National Institute of Neurological Disorders and Stroke that will determine the accuracy and reliability of this method for diagnosing spasmodic dysphonia. Where can I get more information? The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. For more information, additional addresses and phone numbers, or a printed list of organizations, contact: NIDCD Information Clearinghouse

Question: In medicine, dysphonia is difficulty in doing what?
Answer: Speaking