Laryngeal dystonia (spasmodic dysphonia)

Laryngeal dystonia/spasmodic dysphonia, a focal dystonia, involves involuntary

contractions of the vocal cords causing interruptions of speech and affecting the
voice quality. One of the most characteristic features of spasmodic dysphonia is the
patterned, repeated breaks in speech. Symptoms of spasmodic dysphonia come
in several varieties. Symptoms can be broadly divided into two forms: adductor
and abductor. The more common adductor type causes a tight, strangledsounding voice quality, often with abrupt starting and stopping of the voice. The
abductor type causes a breathy, whispering voice. Most cases of spasmodic
dysphonia/laryngeal dystonia are primary and develop in adults.
Terms used to describe laryngeal dystonia include: spasmodic dysphonia (SD);
adult-onset focal dystonia.
Symptoms
Symptoms of spasmodic dysphonia come in several varieties. One of the most
characteristic features of spasmodic dysphonia is the patterned, repeated breaks
in speech. Spasmodic dysphonia can be broadly divided into two varieties:
adductor and abductor. In the more common adductor type, speaking causes
abnormal involuntary excessive contraction of the muscles that bring the vocal
cords together. This causes a tight, strangled-sounding voice quality, often with
abrupt starting and stopping of the voice resulting in a broken speech pattern and
short breaks in speech.
In the abductor type, there is an overcontraction of the muscles that separate the
vocal cords. The vocal cords are held apart, resulting in a breathy, whispering
voice.
Other sub-types of spasmodic dysphonia have been identified by clinicians. One is
a combination of adductor and abductor symptoms in which an individual may
demonstrate both types of spasms as he/she speaks. In a second subtype, symptoms
are accompanied by a voice tremor. A third subtype involves a primary voice
tremor that is so severe the patient experiences adductor voice breaks during the
tremor.

Symptoms may improve or disappear when whispering, laughing, or singing.

Many of the symptoms vary during the day, become aggravated by certain
speakingespecially talking on the phoneor increase during stressful situations.
Although it can start any time during adult life (and very rarely in adolescence),
spasmodic dysphonia seems to begin frequently in people between 40-50 years old.
Cause
Most cases of spasmodic dysphonia are primary, meaning that it is the only
apparent neurological disorder, with or without a family history. In most
individuals, the cause of spasmodic dysphonia is unknown. The general medical
consensus is that spasmodic dysphonia is a central nervous system disorder and a
focal form of dystonia. Researchers are investigating possible mechanisms
involved in the triggering of spasmodic dysphonia including genetic factors,
inflammation, and/or injury that may lead to changes in the central nervous system
that impact motor control of the vocal cords.
Spasmodic dysphonia may occur with other dystonias such as blepharospasm,
oromandibular dystonia, or cervical dystonia.
Diagnosis
Spasmodic dysphonia is reported to be one of the most frequently misdiagnosed
conditions in speech-language pathology. Because there is no definitive test for the
spasmodic dysphonia, the diagnosis rests on a physicians ability to identify the
symptoms and signs in the absence of other conditions that may mimic spasmodic
dysphonia.
It is important that an interdisciplinary team of professionals evaluate and provide
accurate diagnosis. This team usually includes a speech-language pathologist who
evaluates voice production and voice quality; a neurologist who carefully searches
for other signs of dystonia or other neurological conditions; and an
otolaryngologist who examines the vocal cords and their movements.
The excessive strain and misuse of muscle tension dysphonia, the harsh strained
voice of certain neurological conditions, the weakened voice symptoms of
Parkinson's disease, certain psychogenic voice problems, and voice tremors are
often confused with spasmodic dysphonia.

Treatment
The treatment of choice for most cases of spasmodic dysphonia is regular
injections of botulinum toxin into the vocal cord muscles. Voice therapy is often
incorporated into the treatment plan, especially before and after the injections.
Oral medications may also be tried but typically provide little relief in the
symptoms of spasmodic dysphonia.
A form of surgery called selective laryngeal adduction denervation and
reinnervation (SLAD/R) may be an option for some individuals with adductor
spasmodic dysphonia/laryngeal dystonia. Botulinum toxin injections may or may
not be needed following the surgery.
Speech/voice therapy can help minimize spasms and the effects of the spasms.
Fatigue is often a significant component of spasmodic dysphonia/laryngeal
dystonia because it may take a great effort to speak. Voice therapy techniques that
focus on controlling the breath and using the breath to make the most of the voice
may be surprisingly helpful.
http://www.dystoniacanada.org/about-dystonia/focal-dystonias/laryngeal-dystonia