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Spasmodic Dysphonia

by Clarence T. Sasaki, MD

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.

In the adductor type of 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. The less common abductor form results in sudden interruptions of sound caused by momentary abduction of the vocal cords accompanied by audible escape of air during connected speech.

Surgery has been more successful than other approaches for adductor spasmodic dysphonia. The use of botulinum toxin injection has restored a normal voice in 70% of patients for up to 3 mo. Because the effect is temporary, injections may be repeated. There is no known permanent alleviation of the abductor form of this disorder.

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