The organization is dedicated solely to finding answers for these rare voice conditions, in the hope of helping those who are diagnosed with spasmodic dysphonia. He has been public about being diagnosed with this rare voice condition. The recent news about Robert F. Kennedy’s entry into the 2024 Presidential race has brought attention to his unique voice sound.
Hear RFK, Jr. Discuss his diagnosis of spasmodic dysphonia.
Dysphonia spasmodic, also known as abductor or adductor dysphonia spasmodic, is a chronic neurological voice disorder that results in involuntary spasms of the vocal folds muscles, causing a voice that is breathy or strained/strangled with breaks. It is a focal laryngeal dystonia disorder and a chronic neurological voice disorder.
What are Common Treatment Options for Spasmodic Dysphonia?
You can enhance the quality of your life and manage your symptoms by partnering with your healthcare team to evaluate all the treatment options available for spasmodic dysphonia.
Voice Therapy
Voice therapy, provided by a specialized speech-language therapist, can teach individuals strategies to better manage symptoms of spasmodic dysphonia (SD) and improve their quality of life. In addition to counseling and appropriate vocal health habits, education on SD and coping strategies can be provided to individuals seeking Botox injections as an adjunct therapy for the disorder. Therapy should incorporate individual goals and strategies for speaking on the phone, speaking in groups, and speaking with less effort. People with SD may benefit from re-coordinating the speech subsystems in a more efficient way, which can help manage symptoms such as effortful and breathy speech, roughness, strain, and breaks. However, it is important to note that voice therapy cannot cure SD, as it is a neurological disorder.
Botulinum Toxin Injections
The recent few Botox injections, individual reactions, and suggestions of the treating professionals will be determined by the preferences of the individual, discussion of one-sided versus both-sided injections, and specific amount of Botox used. Injecting only one side of the voice mechanism allows for the choice of one-sided injections, resulting in a weaker or shorter-lasting effect of Botox, but also with fewer side effects after the injection. These side effects usually don’t last long, but may become more significant as the amount of Botox increases. The treating ENT or speech language pathologist may provide individuals with strategies to manage these effects during the injection. Individuals may temporarily experience side effects such as breathiness, difficulty swallowing, or pain/soreness at the injection site. The duration of Botox’s benefits varies from person to person, but typically lasts 3-4 months. This weakening effect is only temporary, so Botox injections need to be repeated. The specific laryngeal muscle that is injected depends on the type of spasmodic dysphonia; usually the thryoarytenoid (TA) muscle for adductor type and the posterior cricoarytenoid (PCA) for abductor type. The most commonly used brand for spasmodic dysphonia is currently Botox, which works by blocking nerve impulses at the muscle receptor site that normally signal the muscle to contract, thus eliminating spasms of the muscles that control the vocal folds. Botulinum toxin is injected into the laryngeal muscles that control the opening (abduction) and closing (adduction) of the vocal folds.
How is Spasmodic Dysphonia Diagnosed?
The evaluation of voice includes a comprehensive assessment conducted by a speech-language pathologist and an otolaryngologist (ENT), generally. This evaluation may involve obtaining aerodynamic and sound-based measures to gather more information about the coordination and functioning of the voice, as well as determining the presence of tension in the neck and around the larynx through palpation. Additionally, a recording of the voice may be requested to evaluate specific qualities such as breathiness, strain, roughness, breaks, severity, and overall ratings of different voice qualities. Detailed visualization of vocal fold movement can be achieved through endoscopy, using a special camera inserted through the mouth or nose, or through a review of vocal fold movement using stroboscopy. This comprehensive evaluation also includes collecting a detailed medical history.
Is the Cause of Spasmodic Dysphonia Known?
The exact cause of spasmodic dysphonia is not currently known, but the origin is believed to be neurological. The investigation into the specific causes of this disorder is ongoing, and it is thought that different areas of the brain may be involved. Researchers are focusing on the basal ganglia, which helps regulate movement, and the cortex, which initiates sensation and movement and aids in balance control. Additionally, there may be a genetic component, as genes have been identified in other forms of dystonia.
Differentiating Spasmodic Dysphonia from Related Voice Conditions
All of these factors make it challenging to accurately diagnose dysphonia spasmodic. Additionally, symptoms of dysphonia spasmodic can vary highly between individuals and within individuals. Individuals may try to compensate for symptoms of dysphonia spasmodic by increasing tension/muscle strain, which may result in increased breathiness or tremor. Often, dysphonia spasmodic can mimic or co-occur with other vocal disorders, such as MTD, tension dysphonia, muscle tremor, or other types of disorders.
Surgical Options
The treating ear, nose, and throat specialist should discuss potential risks and benefits if surgery is an option. Either through a surgical cut or with an injection through the front of the neck, a silicone implant or an insoluble injection material is placed in Bilateral Vocal Fold Medialization for abductor spasmodic dysphonia. Research is still being conducted on long-term outcomes. However, with less severe spasms, this may lead to a weaker or more breathy voice. In Type II Thyroplasty surgery, the vocal folds are slightly separated to result in less severe spasms. The muscles are reinnervated with a different nerve by cutting the recurrent laryngeal nerve which innervates the thyroarytenoid and lateral cricoarytenoid muscles in Selective Laryngeal Adductor Denervation-Reinnervation (SLAD-R). Surgeries are designed to treat adductor spasmodic dysphonia. Various surgical options exist to address spasmodic dysphonia.
Quality of Life Effects of Spasmodic Dysphonia
A few studies have documented the psychosocial factors and impaired quality of life in individuals with spasmodic dysphonia. Many individuals with SD feel that their voices don’t accurately portray their emotions, competence, and personality. These individuals experience a range of negative changes in their personal relationships and reduced social participation, including loss of job, salary, or forced career change. They also experience emotional distress, as well as functional and emotional losses, including physical experiences.
Additional research is required along with the necessity for broadening treatment alternatives for the SD community, counseling, and education. These discoveries emphasize the significance.