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Spasmodic Dysphonia

Spasmodic Dysphonia (SD)

Maybe you, or somebody you’ve heard has a voice that sounds tight, strangled, broken, whispery, or otherwise “not quite right.” It may be a condition called spasmodic dysphonia (SD).

Spasmodic dysphonia belongs to a family of neurological disorders called dystonias. A dystonia is a movement disorder that causes muscles to contract and spasm involuntarily.  Certain dysphonias, including SD, are task-specific, meaning that the muscles spasm only when they are used for particular actions and not when they are at rest. When a person with SD attempts to speak, involuntary spasms in the tiny muscles of the larynx cause the voice to break up, or sound strained, tight, strangled, breathy, or whispery. The spasms often interrupt the sound, squeezing the voice to nothing in the middle of a sentence, or dropping it to a whisper. However, during other activities, such as breathing and swallowing, the larynx functions normally.

SD seems to begin more often when people are middle-aged, although it can start at any time during life. The disorder affects women more often than men. Onset is usually gradual with no obvious explanation. Symptoms usually occur in the absence of any structural abnormality of the larynx, such as nodules, polyps, carcinogens, or inflammation. People have described their symptoms as worsening over an approximate 18-month period and then remaining stable in severity from that point onward. Some people have reported brief periods of remission, however this is very rare and the symptoms usually return.

Treatment of SD

Similar to other problems affecting the larynx, SD can be approached with a single type or a combination of treatments, as no single strategy will be appropriate for every case.  SD treatment falls into two categories: medical therapy and surgery.  Medical therapy is with injection of tiny amounts of botulinum toxin (Botox) to the muscles in the vocal folds.   Delivery at Westside Head & Neck is done trans-cervically (directly through the neck skin, without need for anesthesia of any sort or EMG) and takes approximately 5 seconds per side.  There is minimal discomfort, and it is effective and without side-effects over 90% of the time.  Surgery is reserved for patients who do not improve adequately with Botox and who do not live in reasonable distance from a Laryngologist who can deliver Botox every 3-6 months.

Perseverance and patience are important when dealing with SD, and finding the best treatment for each individual involves time and a team effort with the patient and their doctor.