Spasmodic dysphonia (SD) is a neurologic voice condition that impacts the laryngeal musculature when speaking. This condition causes you to have “voice breaks” or “choppy” sounding voice when saying certain words.
In addition to botulinum toxin injections, there are a few surgical options, which are less commonly used and are reserved only for medically refractory cases. These options involve operating on the nerves to your larynx or on the larynx itself; however, these procedures are very uncommonly performed. Some oral medications have been used, but provide less desirable effects than botulinum toxin.
Spasmodic Dysphonia Causes
The exact cause of SD is still unknown. We do know that SD is a focal dystonia. Abnormal signals between the brain and the affected vocal fold muscles leads to abnormal involuntary muscle contraction, usually during specific voicing tasks.Spasmodic Dysphonia Symptoms
Patients with SD have an abnormal voice quality that might be worse with certain words more than with others. Patients may report more effort with speaking and other people may have difficulty understanding you. The voice may sound “strained” or “tight”, or completely cut out with certain sounds during connected speech. Some types of SD may also cause unexpected breathy breaks during speech.Spasmodic Dysphonia Diagnosis
Our voice care team at the Voice and Swallowing Center has the advanced training and skills necessary to diagnose this voice condition. During the initial visit, you will be assessed by one of our laryngologists and likely, an additional session with one of our voice pathologists. We use cutting-edge diagnostic tests to determine the cause of your voice disorder and to develop your plan of care. Following a thorough discussion of your symptoms and medical history, be expected to undergo the following assessments:
- Video Laryngostroboscopy: Using a small camera inserted through the nose or mouth, our specialists are able to assess the health and function of your larynx (voice box) and determine the presence of any vocal fold abnormalities.
- Perceptual, Acoustic, and Aerodynamic Voice Evaluation: This is a comprehensive assessment of multiple voice parameters completed by the voice pathologist.
Wake Forest Baptist Treatment
There is no cure for spasmodic dysphonia. Botulinum toxin (e.g., Botox®) injection into the affected muscles has been standard treatment for SD since the 1980’s. This quick procedure can be carried out easily at our Voiceand Swallowing Disorders Center. The impact of botulinum toxin typically last months and will be repeated when the effect starts to wear off. While this treatment is very beneficial for most patients, it can take a few injections before getting the “right” dose specifically for you. You may need to discuss adjustments in the dose with your laryngologist if you do not get the ideal outcome. We will work to provide an individualized treatment plan for you. Patients who exhibit compensatory muscle tension/vocal strain when speaking, even after undergoing Botox treatment, may benefit from a trial of voice therapy.In addition to botulinum toxin injections, there are a few surgical options, which are less commonly used and are reserved only for medically refractory cases. These options involve operating on the nerves to your larynx or on the larynx itself; however, these procedures are very uncommonly performed. Some oral medications have been used, but provide less desirable effects than botulinum toxin.