Spasmodic Dysphonia
This post seemed appropriate since Spasmodic Dysphonia was recently in the news. The voice Lupita Nyong’o uses for the character Red was inspired by spasmodic dysphonia. This enraged many patients with this disorder because it portrayed the voice of an evil character. The voice was described by one of her cast mates as “scary.”
The actress has since apologized to the spasmodic dysphonia community. She said she was trying to shed light on a not-so-well-understood disorder.
What Exactly Is Spasmodic Dysphonia?
Spasmodic dysphonia (SD) is a neurological voice disorder that causes voice changes. These voice changes depend on the type of spasmodic dysphonia a person has. There are 3 types.
The most common type is adductor spasmodic dysphonia (ADSD). The typical features of this type are phonation breaks and a strained-strangled vocal quality.
A second type is abductor spasmodic dysphonia (ABSD). Breathy voice breaks typically occur in this type – especially after voiceless consonants.
There is also a mixed-type of spasmodic dysphonia that includes aspects of both abductor and adductor types.
In ADSD, spasms occur in the vocal musculature that closes (adducts) the vocal folds. This is what causes the phonation breaks after voiced consonants or in words that start with vowels. This type of spasmodic dysphonia is sometimes confused with muscle tension dysphonia. In ABSD, the spasms occur in the vocal musculature that opens (abducts) the vocal folds. This causes the breathy voice breaks – especially after voiceless consonants (think /p/, /t/, /k/, /h/, etc.)
What Causes Spasmodic Dysphonia?
The exact cause of SD is unknown; however, there are currently researchers looking into this. They are looking at possible genetic components, as well as several different areas of the brain including: the basal ganglia (regulates movement), the cerebellum (improves coordination and balance), and the cortex (responsible for the initiation of movements as well as awareness of sensations).
Who Should Perform the Evaluation?
The best specialist to seek out for evaluation of spasmodic dysphonia is a laryngologist and speech pathologist (voice specialist) team. The evaluation will usually include a laryngoscopy/stroboscopy procedure to look at the structure and function of the vocal folds using a strobe light and special camera to view vocal fold vibratory patterns, a detailed medical history and history of the voice problem, perceptual assessment (provides specific description of the vocal quality), and acoustic and aerodynamic measures of the voice obtained through voice recordings using special equipment.
What Kinds of Treatments Are Available?
Ok. The physician determines the patient has SD. What then? Several treatment options may be offered. Typically, SD responds well to Botox injections into the vocal fold muscles on both sides known as the thyroarytenoids (for adductor type), or into one side of the laryngeal muscles responsible for opening the vocal folds known as the posterior cricoarytenoid muscles (for abductor type). Botox is a neurotoxin that blocks impulses from the nerve to the muscle. It is currently the “Gold Standard” treatment for spasmodic dysphonia.
Botox is currently the “Gold Standard” treatment for spasmodic dysphonia.
This reduces the spasms. Unfortunately, the Botox will wear off. The patient will need to return for repeat injections at regular intervals in order to maintain good voicing.
Another option for treatment includes voice therapy with a speech pathologist. While voice therapy cannot affect the spasms themselves, it can work toward re-alignment of the subsystems of voicing (respiration, phonation, and resonation), and reduce extraneous muscle tension, which frequently accompanies spasmodic dysphonia.
A third option for treatment may be surgical intervention including procedures that either resect and reconstruct the nerve feeding the larynx (the recurrent laryngeal nerve), separate the vocal folds (for adductor types), or move them closer together (for abductor types). Surgery has the risks associated with anesthesia and may not work as well as hoped.
The voice care team will discuss the risks and benefits of each treatment option. Then, the person with SD and the medical staff will determine the best course of action.
The Bottom Line
While there is no cure for SD, the condition can be managed. Researchers are continually looking for the underlying causes of the condition so we can improve treatment, and possibly find a cure. In the meantime, people with SD continue to pursue the treatment options available while continuing on with their social, work, and personal lives.
If you want to learn more about SD, I encourage you to check out the National Spasmodic Dysphonia Association website at www.dysphonia.org where there are some great resources.