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Spasmodic dysphonia
Definition
Spasmodic dysphonia is difficulty speaking due to spasms (dystonia) of the muscles that control the vocal cords.
Alternative Names
Dysphonia - spasmodic
Causes
In the past, spasmodic dysphonia was thought to be caused by a psychological, instead of a physical problem. However, many people now believe that it stems from a problem in the brain and nervous system. The vocal cord muscles spasm, causing the vocal cords to get too close or too far apart while people with the condition are using their voice.
Spasmodic dysphonia usually occurs between ages 30 and 51. Women are more likely to be affected than men.
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 (known as adductor dysphonia).
Sometimes, the voice is whispery or breathy (abductor dysphonia).
Some people will find that the problem goes away when they laugh, whisper, speak in a high-pitched voice, sing, or shout.
Some patients will have muscle tone problems in other parts of the body (such as writer's cramp).
Treatment
Patients with spasmodic dysphonia should see an ear, nose, and throat doctor to check for changes in the vocal cords and other brain or nervous system problems.
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 a period of 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 patients.
References
Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 13.
Blitzer A, Alexander RE, Grant NN. Neurologic disorders of the larynx. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 60.
Lyons MK, boucher OK, Evidente VGH. Spasmodic dysphonia and thalamic deep brain stimulation: long-term observations, possible neurophysiologic mechanism and comparison of unilateral versus bilateral stimulation. J Neurol Neurophysiol.
Reviewed By: Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
