Spasmodic Dysphonia

Spasmodic Dysphonia Definition

It is a condition marked by speech difficulties caused due to Dystonia or spasms of the muscles controlling the vocal cords. It is a peculiar communication disorder that was once considered to be associated with psychological problems.

SD usually arises in individuals aged between 30 and 51. Women are likelier to suffer from this disease than men. The condition is also referred to as “Laryngeal Dystonia”.

Spasmodic Dysphonia Types

Medical researchers have classified Spasmodic Dysphonia (SD) into three primary types. These are

Adductor Spasmodic Dysphonia

In this variation, sudden uncontrolled muscular movements or contractions spasms make the vocal cords stiffen and stick together. These make vibration difficult for the vocal cords and consequently disturb voice production. Words are often interrupted. It also becomes difficult to utter words due to the spasms. This can make speech jerky and make the affected person sound as if he or she is stuttering. The voice of an individual affected by this condition is usually defined as strangled or strained. Stress is found to make the spasms more severe in nature.

Abductor Spasmodic Dysphonia

In this disease, rapid involuntary spasms or movements in muscles lead to the opening of the vocal folds. The vocal folds fail to vibrate while they are open. The open posture also lets air escape from the lungs while speaking. This often makes it sound as if affected individuals are talking in a weak voice or a breathy whisper.

Strangely in both Adductor and Abductor Spasmodic Dysphonia, the muscular spasms are generally found to be absent during

Laughing
Shouting
Talking at a high pitch
Talking while breathing

Spasm are also found to be absent while singing, though there can be a loss of range or an inability with projection or production of certain notes of a scale.

Mixed Spasmodic Dysphonia

It involves muscles that close the vocal folds as well as those that open them. As the name suggests, it includes symptoms of both of the other types of Spasmodic Dysphonia.

Spasmodic Dysphonia Symptoms

The three types of this disorder have varied effects on the way people speak, with each type causing slightly dissimilar speech problems. The typical symptoms of Spasmodic Dysphonia involve:

Broken voice
Hoarse or grating voice
Stuttering speech
High pitched voice
Wavering voice
Strangled or strained voice (as in Adductor Dysphonia)
Breathy whispery tone (as in Abductor Dysphonia)

These symptoms may arise frequently or only from time to time, depending on the severity. Certain patients are found to experience problems in muscle tone (such as Writer’s Cramp) in other regions of the body.

Spasmodic Dysphonia Causes

SD was earlier believed to be a result of a psychological, rather than a physical problem. However, it is now commonly supposed to arise from a defect in the nervous system and the brain. Spasms in the vocal cord muscles cause them to get too far apart or too close while speaking. A dysfunction of larynx muscles (the muscles located in the larynx or voice box) is supposed to be the main cause of this problem. An involuntary movement of these muscles creates problems during speech.

SD can involve various muscles in the human body. The type of SD that a person suffers from depends on the different actions of these muscles.

Spasmodic Dysphonia Diagnosis

Patients of this condition usually consult general practitioners about the diagnosis of this problem. Physicians may refer them to speech language experts, neurologists or Otolaryngologists, better known as Ear-Nose-Throat (ENT) doctors. Spasmodic Dysphonia patients should initially consult ENT doctors who can look for any variations in the vocal cords and check the presence of other brain or neurological problems.

Otolaryngologists generally analyze the vocal folds to detect possible causes for the voice problems. Most of them use a method known as Fiberoptic laryngoscopy to assess vocal cord movement during voice communication. The procedure involves passing a small lighted flexible tube through the nose and ultimately entering it into the throat. Additional tests may involve use of Stroboscopy, which lets physicians look at the vocal cord vibrations in slow motion.

Speech-language pathologists evaluate the voice as well as voice quality of a patient. Neurologists make a careful assessment of the patient to look for symptoms of other movement disorders.

Unfortunately, diagnosis of this disorder often gets delayed. This usually occurs due to lack of identification of its symptoms by medical screening.

Spasmodic Dysphonia Treatment

Treatment approach used for this condition may vary. Standard cure may involve Speech Language Therapy. Some patients get relief with the aid of repeated Botox (Botulinum toxin) injections, which can soothe muscular spasms and make talking much easier. Botulinum toxin is elicited from a particular kind of bacteria. Very small quantities of this toxin may be injected into the muscles located around the vocal cords. The treatment often helps control speech problems for a span of 3 – 4 months.

Some other curative methods used are:

Voice Therapy

Voice therapy is a behavioral method that involves

Vocal Hygiene
Vocal exercises
Vocal relaxation
Respiratory support management
Daily plan for averting straining, misuse and over-use of voice

Voice therapy is used as a standard mode of treatment for many voice disorders. It is conducted by licensed and certified speech-language pathologists after an examination of the vocal fold. It is generally used to restore voice quality to its highest level and is best used after a surgery or injury. However, voice therapy is not found to yield effective results in curing SD. Medicines and voice therapy are usually able to improve minor cases of the condition. More severe cases, where voice therapy or medications fail to improve symptoms, require surgical treatment.

Speech Therapy

Speech therapy offers moderate to good results. If used along with relaxation techniques, it may help improve Minor Adductor Overactivity.

Surgery

Vocal Cord Surgery, which involves cutting one of the nerves to the vocal cords, is another method for curing the disease. It is not usually preferred and kept as a later option. This is because the method provides affected individuals with temporary relief for a few months or few years. It may also damage the vocal cords and lead to permanent inability in verbally communication. Surgery, even when conducted, is not found to be very effective.

National Spasmodic Dysphonia Association

The NSDA is an organization that aims to improve the lives patients affected with SD. It promotes and supports medical research regarding the causes and treatments for the condition. It also advances public and medical awareness of the disease and provides support to individuals affected by SD.

The symptoms of SD arise slowly and worsen over time. Unfortunately, it cannot be totally cured as yet. However, Botulinum Toxin (Botox) injections have been proven to yield effective results in improving SD symptoms and have significantly changed its prognosis. If you have anyone displaying symptoms of the disease in your family, get immediate medical attention to achieve a faster relief from symptoms.

References:

http://www.nlm.nih.gov/medlineplus/ency/article/000753.htm

http://emedicine.medscape.com/article/864079-treatment#a1128

http://www.bcm.edu/neurology/parkinsons/?pmid=14196

http://www.dystonia-foundation.org/pages/more_info___laryngeal_dystonia__spasmodic_dysphonia_/52.php