spasmodic dysphonia overview

In a nutshell, there is no diagnostic test for spasmodic dysphonia. The cause or causes are unknown. Professionals do not agree on the definition of spasmodic dysphonia. There is no proof that a spasming voice has only one cause. It could be that a number of conditions can cause a similar sounding voice. However, once the voice starts spasming, it rarely straightens itself out. Vocal intervention and retraining seem to be required to regain control of the voice. Most doctors simply prescribe botox injected into the vocal cords every few months for life to partially paralyze the vocal cords and thereby stop the spasming.
Spasmodic Dysphonia
The voice condition Spasmodic Dysphonia is defined as momentary disruption of the voice caused by involuntary movements of one or more muscles of the larynx (or voice box).The term spasmodic dysphonia loosely means bad voice caused by spasms of the larynx. This description of the voice problem makes no assumptions about the cause.
The American Speech and Hearing Association (ASHA) and many doctors say there can be several causes of spasmodic dysphonia. The National Spasmodic Dysphonia Association, however, holds that spasmodic dysphonia by definition is a focal dystonia, an incureable neurologic disorder probably caused by a malfunction of the basal ganglia portion of the brain.
There is no diagnosic test for spasmodic dysphonia, regardless of the suspected cause. Based on how the voice sounds, doctors have described two types: adductor, where the vocal folds close too tightly, and abductor, where the vocal folds do not close completely. While much is written about the different types, both problems are an imbalance of airflow and vocal cord vibration.
Regarding Adductor as opposed to Abductor Dysphonia and quoting from “Laryngeal Dystonia ” by Mitchell Brin, Andrew Blitzer and Celia Stewart inDystonia 3: Advances in Neurology, Vol. 78:”Patients with adductor SD exhibit a choked, strained-strangled voice quality with abrupt initiation and termination of voicing resulting in short breaks in phonation. Patients with abductor SD exhibit a breathy, effortful voice quality with abrupt termination of voicing resulting in aphonic whispered segments of speech.”
The voice may vary from day to day, sometimes sounding normal. Typically when a person laughs spontaneously, the voice is normal.
Dr. Robert Bastian has an excellent demonstration of spasmodic dysphonia and its variants at His last statement, however, sends you to the National Spasmodic Dysphonia Association, an organization heavily subsidized by Allergan, the makers of botox.
A good explanation and list of famous people with spasmodic dysphonia can be found at
Muscle Tension Dysphonia can sound like spasmodic dysphonia, and is much more common than spasmodic dysphonia. MTD can be cured or helped by speech therapy designed to relieve the tension and teach the patient how to use correct speech techniques. MTD can also respond to botox, the normal treatment for SD.

Some people diagnosed with spasmodic dysphonia have overcome it with speech therapy and voice work. See “Success Stories” on this site.

The medical profession in general states that spasmodic dysphonia is incurable and can only be treated with botox or surgery. Yet talented voice specialists are proving this is not the case.

Dr. Morton Cooper has reported successes for several years, but does not publish success ratios with SD on his website. Patients of vocal coaches, including Roger Love and Gary Catona, have reported success in overcoming spasmodic dysphonia. A few years ago, a speech language pathologist, Connie Pike, was stricken with SD and overcame it with voice therapy and breathing lessons.

Roger Love did trial studies with several SD patients, and Connie Pike and Mike White offer an intensive voice and breathing workshop for SD sufferers (See Some SD patients eported improvement with Zhou’s Hypoxicology Therapy(ZHT). As more practitioners are trained and more SD patients try it, we will have a better idea of its success.

Both of the traditional treatments for Spasmodic Dysphonia, botox and surgery, take a healthy body part and damage it in order to make up for a problem elsewhere. Both are expensive. Botox is derived from botulinum toxin, the most deadly poison known to man, and has to be injected into the vocal cords every few months for life. Followups on surgical patients reveals a high rate of return to the original problem, or to even worse problems.

Gastroesophageal Reflux as Cause of Laryngeal Spasms
Spasms of the larynx can also be caused by GERD (gastroesophogeal reflux). The patient may have GERD even though he has no heartburn. Dr. Jamie Koufman in “The Differential Diagnosis of Paradoxical Vocal Cord Movement” says this:

Paroxysmal Laryngospasm and PVCM Due to Gastroesophageal Reflux
Gastroesophageal reflux can cause a true intermittent type of PVCM, laryngospasm, or both, in which adduction predominates and abduction is temporarily lost during “attacks.”3-5 Thus, laryngospasm may be considered a specific variation of PVCM. Using this definition, reflux appears to be the most common cause of PVCM.5 In either case, the attacks of respiratory obstruction are paroxysmal and the result of direct contact of gastric fluids with laryngopharyngeal structures.5 It is postulated that some additional form of vagal dysfunction may prolong the episodes for minutes, hours, or sometimes days.6,7 [End of Quote}

Muscle Tension Dysphonia
There is no diagnostic test that can differentiate spasmodic dysphonia from muscle tension dysphonia, which can sound the same but is caused by muscle tension. Brain scans of SD patients are no different from brain scans of other people. People with Muscle Tension Dysphonia should not try to apply the research on spasmodic dysphonia to their own cases, since they have totally different causes. Yet these people are often lumped in with SD patients because the voices can sound the same.
If the voice symptoms are caused by a malfunction of the brain, then the signal is scrambled before it gets to the vocal muscles. If the voice symptoms are caused by muscle tension, then the correct signals are being sent by the brain but are not acted on properly by the vocal muscles due to muscle tension.
Whatever the underlying cause of vocal fold spasms, voice production patterns can become quickly habituated in the brain, and can be difficult to change. Your brain develops a “voice image” and faithfully tries to reproduce it.

AND Finally

We applaud the people who try to help spasmodic dysphonia patients. Since the medical community admits that it does not know the cause or cure, then they CANNOT RULE OUT anything until a specific scientific study has been done to either refute or corroborate a possible cause or cure.

Since the National Spasmodic Dysphonia Association, supposedly a patient organization, is heavily financed by Allergan, the makers of Botox, we must ask if they are truly unbiased in the views they present. Since much of the research in Universities is also financed by Allergan, we must ask what important research is not explored because of the source of funding.
My personal pet peeve is to have self-proclaimed authorities and organizations scoff at possible treatments, usually saying “There is no evidence that the treatment is effective.” The only accurate statement would be to say that it has never been tested. Just because it hasn’t been tested doesn’t mean it doesn’t work. Until more scientific research is done, the experiences of real live people who have the condition are the best laboratory.

by Micki Nellis of Cleburne, Texas (deceased)