Shania Twain Diagnosed With Dysphonia, Undergoes Therapy to Restore Her Voice

In the recent weeks, country diva Shania Twain has been making many appearances on television surrounding her new book, ‘From This Moment On,’ and television series, ‘Why Not? With Shania Twain.’ What some may have noticed, however, is she has not been doing any singing.

The singer has revealed to E! Online that the years of suppressing and repressing her voice and emotions have done extensive damage to her vocal chords. Twain now suffers from a chronic condition called dysphonia. The condition brings about an impairment in the ability to produce voice sounds. As a result, Twain is currently undergoing therapy to restore her speech, as well as her singing voice.

“I had reached a point in my life where there was a bottleneck, physically, in my throat,” Twain says. “Something had to give. I’ve only just discovered what’s wrong. Next comes rehabilitation, which will take a long time. Physical rehabilitation, voice therapy, learning how to breath again … and the singing will come.”

Twain’s ‘From This Moment On” autobiography is in stores now. The book is also available for purchase through Amazon’s website.

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Vocal chord disorder can be diagnosed as asthma

ORLANDO, Florida – Athletes with a vocal cord disorder that restricts breathing are more likely to be misdiagnosed and inappropriately treated for exercise-induced asthma, according to research presented today at the Triological Society’s 116th Annual Meeting.

Researchers at The Ohio State University Wexner Medical Center also examined interventions ranging from biofeedback to botox injections to help manage the condition – called paradoxical vocal fold motion disorder (PVFMD) – and found that vocal cord “retraining” therapy was effective at reducing or resolving breathing symptoms, allowing many athletes to stop using previously prescribed corticosteroid asthma inhalers.

The retrospective study examined 46 division one collegiate athletes, marathon and triathlon runners who were newly diagnosed with PVFMD, a condition brought on by stress, anxiety or increased exertion which causes the vocal cords to constrict and obstruct breathing. An estimated five percent of athletes have PVFMD, which can severely impact performance.

“There isn’t a lot in the literature about PVFMD in elite athletes, and our study shows that because of their high level of conditioning they may be more difficult to diagnose and treat than non-athletes.” said Brad deSilva, MD, the study’s lead investigator and residency program director for the Department of Otolaryngology-Head and Neck Surgery at Ohio State’s Wexner Medical Center.

For example, only 30 percent of the study group reported consistently experiencing PVFMD symptoms like coughing during exercise. However, in post-exertion testing using a flexible fiberoptic laryngoscope (FFL), researchers ultimately verified PVFMD diagnosis in all but six of the athletes. Additionally, in comparison to a control cohort of non-athletes with PVFMD, athletes were less likely to present with a history of reflux, laryngeal edema or psychiatric diagnosis.

The study presenters noted that the addition of the exercise trigger during FFL improved the researcher’s ability to detect PVFMD, and that clinicians may want to strongly consider FFL examination when dealing with an elite athlete patient with breathing issues, particularly because the respiratory sounds of PVFMD may be confused with asthma.

“PVFMD symptoms can often mimic asthma, and as many as 40 percent of people with asthma also have PVFMD – so it’s typical for an athlete to get the asthma diagnosed correctly, but not the vocal cord dysfunction,” said Anna Marcinow, MD, co-author of the study and a senior resident in the otolaryngology program at Ohio State’s College of Medicine. “Nearly a third of our study athletes had been previously prescribed an inhaler for exercise-induced asthma – but many reported that the inhalers weren’t helping. A minimal response to bronchodilators should also point toward a PVFMD diagnosis.”

After FFL review, 45 of the 46 athletes in the study were prescribed laryngeal control therapy (LCT), a method in which athletes learn how to relax the vocal cords and retrain the way they breathe. Thirty-six athletes attended at least one LCT session and 25 (69 percent) reported improvement of symptoms. Patients who attended two or more sessions were more likely to experience symptom improvement.

Biofeedback, practice observed therapy and thyroarytenoid muscle botulinum toxin injection were utilized in patients that did not respond to LCT.

“Because PVFMD can have both physical and emotional impacts, using tactics that help athletes gain a sense of control over their breathing can be really effective,” said Marcinow. “Athletes may also need additional alternative forms of therapy such as biofeedback or intervention from a sports psychologist.”

The researchers also noted that while PVFMD is first often seen in athletes who have recently intensified activity and training, it can also occur in non-athletes who are adopting a more rigorous exercise program.

Muscle Tension Dysphonia

What is Muscle Tension Dysphonia?

Muscle Tension Dysphonia (MTD) is a voice disorder characterised by strained, effortful voice that can usually tire your voice and in some cases cause damage to the vocal folds if used extensively.

Causes of Muscle Tension Dysphonia?

The cause of MTD is not very well understood.
It may be caused by irritants such as:

  • upper respiratory infection
  • passive smoking
  • acid reflux (heartburn)
  • excessive demand placed on your voice or stressful life events.
  • Often, it is likely that more than one of these factors contribute to MTD.

two types of MTD:

Primary MTD – in this type the muscles in your neck are tense when using your voice but there is no abnormality in the Larynx (“voice box”).
Secondary MDT – in this type there is an abnormality in the voice box causing you to over-use other muscles to help produce voice.

What are the symptoms of Muscle Tension Dysphonia?

Changes to your voice:

  • Your voice may sound husky, hoarse, breathy and/or rough.
  • The loudness of your voice may decrease.
  • You may find it difficult or effortful to make yourself heard in a noisy environment.
  • Your voice may become deeper.
  • The sound of your voice may deteriorate with prolonged voice use.

Adductor spasmodic dysphonia

This is the the type of spasmodic dysphonia I have; adductor spasmodic dysphonia,
or in short ADSD.

With this type, your voice sounds strangled and it requires a lot of effort
to push your voice out.

Workings of adductor spasmodic dysphonia

This is the most common form of spasmodic dysphonia. It is characterized by spasms that cause the vocal folds to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce sounds. Words are often cut off or are difficult to start because of muscle spasms. Therefore, speech may be choppy. The voice of someone with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. The spasms are usually absent—and the voice sounds normal—while laughing, crying, or shouting. Stress often makes the muscle spasms more severe.


Treatment of adductor spasmodic dysphonia

This SD type has the greatest chance of improvement with Botox.
When your doctor is skilled it will be a piece of cake to have the Botox injections
throught he front of your neck. You don’t need any anaestetic, because you will
only feel a small needle prick.

Spasmodic Dysphonia types

The three types of spasmodic dysphonia (SD) are adductor spasmodic dysphonia, abductor spasmodic dysphonia and mixed spasmodic dysphonia.

Adductor spasmodic dysphonia

In adductor spasmodic dysphonia (ADSD), sudden involuntary muscle movements or spasms cause the vocal folds (or vocal cords) to slam together and stiffen.These spasms make it difficult for the vocal folds to vibrate and produce voice. Words are often cut off or difficult to start because of the muscle spasms. Therefore, speech may be choppy but differs from stuttering. The voice of an individual with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. Surprisingly, the spasms are usually absent while laughing, speaking at a high pitch, or speaking while singing, but singers can experience a loss of range or the inability to produce certain notes of a scale or with projection. Stress, however, often makes the muscle spasms more severe.

Abductor spasmodic dysphonia

In abductor spasmodic dysphonia, sudden involuntary muscle movements or spasms cause the vocal folds to open. The vocal folds cannot vibrate when they are open. The open position of the vocal folds also allows air to escape from the lungs during speech. As a result, the voices of these individuals often sound weak, quiet and breathy or whispery. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing or singing, but singers can experience a loss of range or the inability to produce certain notes of a scale or with projection.

Mixed spasmodic dysphonia

Mixed spasmodic dysphonia involves both muscles that open the vocal folds and those that close them and therefore has features of both adductor and abductor spasmodic dysphonia