Spasmodic Dysphonia or “Stuttering of the Vocal Cords”

What is Spasmodic Dysphonia?

Laryngeal Dystonia–also called Spasmodic Dysphonia– is an organic voice disorder caused by dysfunction of center neurological integration that produces spasm of the vocal cords. Spasmodic dysphonia causes the voice to break or to have a tight, strained or strangled quality. There are three different types of spasmodic dysphonia: adductor spasmodic dysphonia (closed glottis), abductor spasmodic dysphonia (open glottis) and mixed spasmodic dysphonia.

In adductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal cords to slam together and stiffen, which makes it difficult for the them to vibrate and produce voice. Words are often cut off or difficult to start and speech may be choppy and sound similar to stuttering. The voice is commonly described as strained or strangled and full of effort.

In abductor spasmodic dysphonia, the sudden involuntary muscle movements or spasms cause the vocal folds to open and stay opened. Thus, vocal cords can not be closed for phonation (to produce the speech sounds). As a result, the voice of these individuals often sounds weak, quiet and breathy or whispery.

Mixed spasmodic dysphonia involves muscles that open the vocal folds as well as muscles that close the vocal folds and therefore has mixed features of both above–mentioned syndromes.

Surprisingly, all three conditions are usually absent while doing vegetative phonation, whispering, crying, laughing, singing, speaking at a high pitch, speaking when just woken up from a sound sleep or after drinking alcoholic beverages ( spasmodic dysphonia is the only voice disorder for which I am allowing my patients to drink some alcohol!) As in many other voice disorders, stress and nervousness will make the muscle spasms even more severe.

Spasmodic dysphonia is a mysterious voice disorder; the cause is yet unknown. Because the voice can sound normal at times, spasmodic dysphonia was once thought to be psychogenic, but as reported by the National Institute of Deafness and other Communication Disorders (NIDCD), research has revealed increasing evidence that most cases of spasmodic dysphonia are in fact neurogenic and may co-occur with other movement disorders such as blepharospasm (excessive eye blinking and involuntary forced eye closure), tardive dyskinesia (involuntary and repetitious movement of muscles of the face, body, arms and legs), oromandibular dystonia (involuntary movements of the jaw muscles, lips and tongue), torticollis (involuntary movements of the neck muscles), or tremor (rhythmic, quivering muscle movements).

NIDCD also reports that spasmodic dysphonia may run in families and is thought to be inherited. Research has identified a possible gene on chromosome 9 that may contribute to the spasmodic dysphonia that is common to certain families. Spasmodic dysphonia can affect anyone between 30 and 50 years of age. More women appear to be affected by spasmodic dysphonia than are men.

Treatment for spasmodic dysphonia?

The “triangle” ENT–Neurologist–SLP is usually on the front line in diagnosing and treating the symptoms of spasmodic dysphonia. There is presently no known cure for spasmodic dysphonia. Current treatments only help reduce the symptoms.

SLP- Voice therapy may reduce some symptoms, especially in mild cases. Voice therapy and vocal cords special physiotherapy may also support a better voice while undergoing the post effects of treatment of choice – see below.

ENT- has two common options:

  1. an operation that cuts one of the nerves of the vocal folds (the recurrent laryngeal nerve) thus improving the voice for several months to several years.
  2. injections of very small amounts of botulinum toxin (botox) directly into the affected muscles of the larynx. Botulinum toxin is produced by the Clostridium botulinum bacteria. The toxin weakens muscles by blocking the nerve impulse to the muscle. Botox 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 that usually subside after a few days to a few weeks may include a temporary weak, breathy voice or occasional swallowing difficulties – this will be the best time to refer the patient to speech therapy , as was mentioned above. Botox may relieve the symptoms of both adductor and abductor spasmodic dysphonia, and is considered to be the main line of defense against spasmodic dysphonia.

Gal Levy M.Sc. CCC-SLP, has more than 21 years of experience in clinical treatments of Voice, Fluency, Articulation and Language. Gal is working as a school based SLP, Home health SLP and in his private practice at Frisco, TX. He also writes professional articles on various speech disorders and state of the art treatments on Google’s new Encyclopedia, Helium and AC writers websites. Gal participated on Community Focus radio monthly shows with Dr. Griffin advising KEOM 88.5 FM listeners on voice, fluency and tongue thrust clinical issues.

Comments

  1. I just saw my first patient in a long time with spasmodic dysphonia yesterday so your post was very timely for me! I have a question. This patient also has vocal tremor and physical tremors which I have seen in the literature as co-occurring. However, another of her symptoms I have not seen mentioned — paraphasias. I heard several of them during the eval and she reported them also as being very frustrating for her. For example, she used ‘Monicare’ for Monica and ‘sposemodic’ for spasmodic. she generally attempts to self-correct but sometimes can’t quite even get that right. Any insights on this?

  2. Thank you – The vocal tremor is connected and could be treated using Vocal cords physiotherapy – you did not mention the SD type…?
    The paraphasias does not seem to be a part of SD…you did not mention the age? It seems more a CNS / cognitive problem – have you screened language? We voice experts tend sometime to forget about language…As you well know your pt. could suffer from several disorders combined…Also, I would check what kind of daily medication does the pt. take? Let me know if that’s helping you?!? Best, Gal

  3. Have you had any success with myofascial release therapy for relieving symptoms of spasmodic dysphonia?

    • No Debbie – I do not believe these are connected…I would use Vocal cords physiotherapy instead – working directly on the VC.

  4. I have recently received a referral from an ENT for a patient with vocal fatigue. Upon review of her chart, I noted her sister has a diagnosis of spasmodic dysphonia and is currently treated with Botox every 3 months. With my patient, she is a young woman. All parameters of acoustic analysis within normal limits. In conversation, some hesitations were noted only with, what seemed to me, would be similar to a block disfluency. No other incidences of spasms are noted, either increased breathiness nor strain. My question is with adductor spasmodic dysphonia, can it only be present at initial onset of phonation? Easy onset is effective in reducing phonatory block. It is not limited to voiced or voiceless onset. Thank you very much!

    • Very interesting indeed….SLP’s are not the ones to decide that…I would advise you to check with her ENT…or Neurologist…We do not know what trigers SD or how to cure it yet.

  5. I am a speech pathologist that has been diagnosed with adductor spasmodic dysphonia after visiting several ENT’s and Voice clinic. Most of them are not inept in this area, so I have resorted to the internet. I was given lidocaine, which had no affect except trouble swallowing and breathing. I recently discovered an SLP in Florida who uses alternative methods of treating this debilitating disorder after she had been diagnosed with SD. She uses a holistic approach in her treatment which includes: breathing, counseling, nutrition, exercises, etc. She claims that she restored her own voice using these methods. My question is if she did this without botox or severing any nerves then why aren’t there more therapist receiving this information?

    • I am in the exact same position as you. I am an SLP that has self diagnosed adductor spasmodic dysphonia. I was doing some research and came across your post. I was wondering if you tried the methods you mentioned and if there were any results. I find that it is very much related to stress and tense muscles. I don’t plan on doing anything about it yet, but if ther is something out there that is completely harmless I’ll be more than willing to try. Thanks.

  6. Kasey – Surely you may try whatever there is to resolve your personal medical problem…As you are a scientist you are well aware that in order to legitimate any new treatment it should undergo an extensive peer review and statistical evaluation on enough people for enough time to be measure as valid….I am sure the other SLP knows about this procedure as well….I would encourage her to approach ASHA or the local COMM Disorders faculty to start the process….unfortunately this is the only way science is advancing…As for you, if this procedure is truly risk free you may give it a try since you don’t have anything to lose ( but money and time…) – best of luck !!!

  7. Dear Emily – I do not have SD myself, I have been using wonderful drills of relax vocal folds physiotherapy and 3 good techniques with SD patients – they have been quite successful to a point especially in mild cases. MBS (midsection breath support – the one you learned in school using abdominal breath support and projection of voice), WMD(sonorantic- Watterson, Mcfarlane and Diamond approach), MMSM(Minimal movements specialization method – from Dr. Weiss) – you’ll find plenty of materials online for them…all the best !
    Gal

  8. Hi. 2 mos ago my daughter had a “normal” cold that lasted 3 days, then she developed a terrible dry cough. As a result she can hardly speak and when she does speak it sounds like a horrible stutter that u can’t understand. She was just told that there is a muscle that isn’t closing her VC properly. Any ideas that u have may be helpful. She was just prescribed, Neurontin.

  9. P.S. she has had brain scan, thyroid work, and been in the hospital twice.

  10. Dear Kimberly – 2 things to do:
    1. Get to a good ENT surgeon and perform a stroboscopic view on the vocal cords. Follow ENT’s medical advice.
    2. Then – search for a good CCC-SLP voice therapist in your area – give him the results of this stroboscopic view to get proper voice evaluation and then possibly good voice therapy including VC physiotherapy.
    Go to your ENT first !!!
    All the best !

  11. I have ABSD and ADSD- mixed spasmodic dysphonia and it is severe.

    I wish that medical professionals who work with SD patients understood that because speech requires so much effort, we who have SD often have significant issues of fatigue when we try to talk. When I was trying to find a diagnosis I asked if exhaustion was characteristic of SD and was told absolutely not. But since diagnosis I’ve learned that most suffer from this, and from social issues like anxiety when we need to use the phone. We struggle with isolation and embarrassment.

    In addition, there are so many practical challenges. Speech pathologists generally don’t get involved since speech therapy doesn’t correct SD, ENTs tend to look at vocal cords only, and we patients are left wondering how to compensate and cope with very little assistance.

    It would be such a gift if someone put together a helpful “toolbox” of ways we can live happily with our disorder. Even NSDA does not offer this help. In my case, I feel as if I’ve been told I’m newly blind or deaf or have lost my legs, but I will have to learn to cope on my own. A die-hard optimist with a great support network, I will eventually find a new “normal”, but I wonder how less hardy souls can possibly rise to this daunting challenge.

    Just a different point of view which might be interesting for speech pathologists who work with people like me.

  12. After intermittent SD for over 50 years, I have concluded that for me it is a social anxiety problem. It is not consistent, it is common when I need to use the phone, order in a restaurant, meet people for the first time, etc. It is somewhat “helped” with a glass of wine or a beer. I am not a drinker beyond the recommended one ounce/day. I have tried xanax and while that does relax me it does not improve my voice. It certainly gives me more confidence or rather a, “I don’t care how I sound” attitude. My New Year’s resolution is to seek out a SLP and try that. My daughter is an SLP in the school system, but thought it was better to have an objective third party involved.

    I have been diagnosed in the past several years with silent partial seizures. The neurologist has wondered if the SD is from that. Since I have had it for so long and since it is more situational, I don’t believe it is. He did talk about an deep brain stimulator such as is used for Parkinson’s tremors. That will be my last resort.

    If anyone has any ideas or anything I may have missed, please let me know. I am a nurse practitioner and have explored the ENT part already.

  13. hi you have any idea about situational vibration on stuttering plz send

  14. iris rich says:

    I developed SD 20 years ago. I was worried for a bit, because I speak in public for a living. My doctor told me to just forget about it. I did that, and have gotten by fine. Occasionally my voice squeaks, but it is not a huge factor in my life.

  15. Hi after I had my daughter a year ago I had a stutter and muscle spasma from head to toe it lasted a week I was given antibiotics and it went away a year later the symptoms came back but not severe I have more stuttering than muscle spasms, I’m waiting for my to see the neurologist does the disorder you have in this article just all of sudden come on and can it be due to stress and fatigue? I’m just trying to figure out why my body is doing this