• Gal Levy posted an update 1 year, 2 months ago


    letter will shed some light on:

    Dysphonia (SD) or “stuttering of the vocal cords”.

    is SD?


    Dystonia or as it 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.


    adductor spasmodic dysphonia, sudden involuntary muscle movements or

    spasms cause the vocal cords to slam together and stiffen. By that

    make it difficult for the them to vibrate and produce voice. Words

    are often cut off or difficult to start, 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 3

    conditions are usually absent while doing vegetative phonation,

    whispering, crying, laughing, singing, speaking at a high pitch

    ,speaking when just woke up from a sound sleep or after drinking

    alcoholic beverages ( SD 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.


    is another 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 NIDCD ( The

    National Institute of Deafness and other Communication Disorders),

    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 SD?

    The “triangle”

    ENT –Neurologist – SLP is usually on the front line in diagnosing

    and treating the symptoms of SD. There is presently no known cure for

    spasmodic dysphonia. Current treatments only help reduce the


    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


    ENT- has 2 common

    options, One: 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.

    Two: 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. This is the bacterium that occurs in improperly canned

    foods and honey. The toxin weakens muscles by blocking the nerve

    impulse to the muscle. The 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 SD.