Spasmodic dysphonia

Spasmodic dysphonia, also known as laryngeal dystonia, is a neurologic disorder that can affect the voice and speech. It is a lifelong condition that causes the muscles that generate a person’s voice to go into periods of spasm. In some cases, the disorder is temporary or can be improved through treatment. Spasmodic dysphonia most commonly begins when an adult reaches middle age. Women are affected more often than men. 

Muscle tension dysphonia is a voice disorder that can present in a similar fashion to spasmodic dysphonia. 

A person with dysphonia may experience:

• Breaks or interruptions in speech, often every few sentences
• A hoarse, grating voice that can also sound strained or strangled or hoarse and breathy (known as adductor dysphonia)
• Odd sounding speech that is difficult to understand
• Gradual or sudden difficulty speaking
• The problem may go away when the person laughs, whispers, speaks in a high-pitched voice, sings, or shouts
• Some people have muscle tone problems in other parts of the body, such as writer's cramp

The exact cause of spasmodic dysphonia is unknown, however, most cases result from a trigger in the brain and nervous system that can affect the voice. Sometimes it is caused by psychological stress.

For muscle tension dysphonia, there is usually an inciting event that leads it to develop, resulting in a strained vocal quality. These events may include:

• Surgery
• Virus
• Inflammatory Illness
• Lesions
• Neurologic conditions such as multiple sclerosis or Parkinson's disease

Dysphonia can be hard to diagnose because the larynx often looks normal. At the Penn Center for Voice, Speech and Swallowing, our specialists draw on their deep experience to accurately diagnose muscle tension disorders such as dysphonia. We use your medical history and assess your speech to listen for voice breaks.

A diagnostic tool called video stroboscopy may be used to rule out other conditions such as nodules, polyps or cancer. Video stroboscopy is a painless, outpatient procedure that uses a synchronized, flashing light to visualize vocal cord vibration. During this exam, a flexible tube (nasopharyngoscopy) equipped with a strobe light and camera is passed through your nose and positioned just above the vocal cords. Alternatively, a rigid telescope can be passed through your mouth — over the tongue — to visualize vocal cords. This light flashes on and off as your vocal cords vibrate. A microphone is placed along your neck to simultaneously detect the frequency of the vocal cords.

Voice and speech disorder specialists at the Penn Center for Voice, Speech and Swallowing are uniquely positioned to treat patients with dysphonia. While there is no cure for this condition, we can offer you relief from your symptoms using the latest treatments available.

One option we might suggest is speech therapy or psychological counseling to help reduce symptoms in mild cases.

Botox injections are also an effective treatment we offer for dysphonia. These injections are delivered via the mouth through electromyography, an imaging tool used to ensure accurate placement of the injection in the muscle. Electromyography uses a very fine needle, also known as an electrode, that is inserted into the muscle to record muscle and nerve activity. Botox injections are given in your physician’s office. The whole treatment takes between one and two minutes. Each Botox injection provides about three months of relief from symptoms and there is no limit to the number of Botox injections you may receive for this condition.

If your dysphonia is caused by a neurological condition, such as multiple sclerosis or Parkinson’s disease, we collaborate with Penn Neurology to ensure you receive the comprehensive, multidisciplinary care necessary.