Spasmodic Dysphonia and Other Medical Conditions (affecting the larynx or “voice box”)

What type of medical conditions can affect the vocal folds?
What is Spasmodic Dysphonia?

What type of medical conditions can affect the vocal folds?

Voice changes do not always originate from how a person uses his/her voice. People may develop voice problems from other medical conditions or surgeries to treat medical conditions. Here are a few examples of voice problems related to (or as a result of) medical conditions or medical treatment:

• neurologic conditions (examples include Spasmodic dysphonia, Parkinson’s disease, ALS, myasthenia gravis)
• surgery to the neck or chest, which can impact the nerves feeding the voice box (examples include vocal cord paralysis or paresis)
• irritative conditions such as allergies and reflux
• pulmonary or breathing conditions
• rheumatologic conditions (example is Sjogren’s, scleroderma)
• hormonal changes (for example, hypothyroidism)
• medications

Most commonly, people have a variety of factors impacting their voice quality. Though medical factors may impact the voice, often there are a number of other components to the voice disorder, including how people compensate for voice problems (vocal strain or muscle tension dysphonia). Because vocal symptoms may be related to a variety of medical, voice use, environmental, and dietary factors, a thorough evaluation by experienced voice specialists is needed to get the best outcome for your voice. As with most voice conditions, treatment will likely involve a combination of medical management and voice therapy. Sometimes surgery may be required to remove lesions which develop on the vocal folds (vocal cords) or surgery may be used to “bulk up” the vocal folds to achieve good closure of the vocal cords for speaking.

One of the common voice disorders is highlighted here:

What is Spasmodic Dysphonia (SD)?

SD is a voice problem resulting from neurologic causes. SD is usually slow in onset and progression, and usually does not impact other parts of the body.

The most common type of SD is the ADDuctor type, where the vocal cords have spasms that bring them together too strongly. People with this type of SD often have a strained or strangled quality to their voice and increased effort to speak. Typically, these patients have problems with sounds like “P”, “T”, or “SH” sounds (as in “PETER,” “TOM, ” and “SHELL”).

ABductor SD is much less common. The vocal cords spasm away from each other resulting in a loss of the volume of the voice and an episodic breathiness that makes it difficult for them people to speak. Typically, these patients have trouble with the “GA” or “RA” sounds (as in “GARAGE”).

Most patients with SD typically have better voices while singing and their voices are made worse by stressful situations. SD usually does not respond to voice therapy alone (by speech pathologists) and requires an integrated approach of medical treatment with voice therapy.

What treatment is available?

Treatment of SD is aimed at restoring the “balance” of the muscles. In some cases, weakening of specific muscles in the voice box can improve the voice.

In the last 15-20 years, Botulinum Toxin A (Botox) has been used to temporarily weaken or paralyze specific muscles. In SD, either the vocalis muscles or the posterior cricoarytenoid muscles are weakened by Botox to improve the voice. The type of SD that a patient has determines which muscle needs to be injected.

Botox is injected through a small needle using signal guidance provided by a neurologist. We use the guidance technique because these muscles are tiny and we can be better assured that the Botox is injected into the exact place it needs to be.

Botox is not a cure for SD but provides temporary improvement in voice symptoms. Patients typically need to have the treatment repeated every 4 to 6 months to maintain good voice quality. Duke University Medical Center has staff with specialized training in the use of Botox for the treatment of SD and other dystonias of the head and neck.

Voice therapy can also be beneficial in helping patients maximize the benefit of the Botox injection and use the voice in the most efficient way possible. Therapy can also help to eliminate any compensatory vocal strain and incoordinated breathing, which often occur when people have tried to adapt to the SD condition.