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Spasmodic dysphonia

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Spasmodic dysphonia is difficulty speaking due to spasms (dystonia) of the muscles that control the vocal cords.

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Causes
Spasmodic dysphonia is sometimes due to psychological stress. Most cases result from a problem in the brain and nervous system. The vocal cord muscles spasm. This causes the vocal cords to get too close or too far apart while a person is using the voice.

Spasmodic dysphonia usually occurs between ages 30 and 51. Women are more likely to be affected than men.

Sometimes, the condition runs in the family.

Symptoms
The voice is usually hoarse or grating. It may waver and pause. The voice may sound strained or strangled, and it may seem as if the speaker has to use extra effort (known as adductor dysphonia).

Sometimes, the voice is whispery or breathy (abductor dysphonia).

The problem may go away when the person laughs, whispers, speaks in a high-pitched voice, sings, or shouts.

Some patients will have muscle tone problems in other parts of the body (such as writer's cramp).

Treatment
Patients with spasmodic dysphonia should see an ear, nose, and throat doctor to check for changes in the vocal cords and other brain or nervous system problems.

Botulinum toxin (Botox) treatments may help. Botulinum toxin comes from a certain type of bacteria. Very small amounts of this toxin may be injected into the muscles around the vocal cords. This treatment will often help for 3 to 4 months.

Surgery to cut one of the nerves to the vocal cords has been used to treat spasmodic dysphonia, but it is not very effective.

Brain stimulation may be useful in some patients.

Alternative Names
Dysphonia - spasmodic

References
Blitzer A, Alexander RE, Grant NN. Neurologic disorders of the larynx. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery . 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 60.

Van Houtte E, Van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice . 2011;25:202-207.

Update Date: 5/28/2014
Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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