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Spasmodic Dysphonia

By Clarence T. Sasaki, MD, The Charles W. Ohse Professor of Surgery and Director, Yale Larynx Lab, Yale University School of Medicine

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Spasmodic dysphonia (vocal cord spasms) is intermittent spasm of laryngeal muscles that causes an abnormal voice.

Cause is unknown. Patients often describe the onset of symptoms following a URI, a period of excessive voice use, or occupational or emotional stress. As a localized form of movement disorder, spasmodic dysphonia has an onset between ages 30 and 50 yr, and about 60% of patients are women.

There are two forms:

  • Adductor spasmodic dysphonia

  • Abductor spasmodic dysphonia

In adductor spasmodic dysphonia, patients attempt to speak through the spasmodic closure with a voice that sounds squeezed, effortful, or strained. These spasmodic episodes usually occur when vowel sounds are being formed, particularly at the beginning of words.

In abductor spasmodic dysphonia, which is less common, sudden interruptions of sound caused by momentary abduction of the vocal cords are accompanied by an audible escape of air during connected speech.


  • For adductor spasmodic dysphonia, surgery, or botulinum toxin injection

For adductor spasmodic dysphonia, surgery has been more successful than other approaches. Injection of botulinum toxin into vocal adductors has restored a normal voice in 70% of patients for up to 3 mo. Because the effect is temporary, injections may be repeated.

For abductor spasmodic dysphonia, no known treatment permanently alleviates the disorder, but temporary improvement has been achieved with botulinum toxin delivered to the posterior cricoarytenoid muscle (sole vocal abductor).