Voice that Catches or Spasms (aka, Spasmodic Dysphonia, Laryngeal Dystonia)

by , last modified on 1/25/14
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Spasmodic dysphonia is a rare voice disorder characterized by sudden strained or breathy voice breaks while talking. This disorder is treated by Dr. Chang using BOTOX which is performed every Friday afternoon. BOTOX normalizes the voice quality and is considered the standard of care for this disorder currently. For more information on the treatment of spasmodic dysphonia, go here. A video demonstrating the technique Dr. Chang uses to inject BOTOX into the vocal cords is shown at the bottom. Of note, video samples are not provided as the anatomy is normal. Of note, tremor and muscle tension dysphonia are often (erroneously) confused for spasmodic dysphonia. A video example of muscle tension dysphonia can be found here.

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How Were These Images/Videos Obtained??? By a Procedure Called Fiberoptic Trans-Nasal Endoscopy...

Example 1: ADductor Spasmodic Dysphonia

Audio - Standard Passage (First is a Severe Case, Second is a Very Mild Case)

Note the sudden choppy and strained voice breaks. The vocal cords come together suddenly when they should not which cuts the voice. Patients generally have more difficulty with voice weighted sentences (ie, counting from 80 to 89) than voiceless weighted sentences (ie, counting from 60 to 69). Also, whispered speech or falsetto voice is easier with fewer breaks. This type of spasmodic dysphonia is the most common form. For this disorder, BOTOX is injected into the thyroarytenoid muscles. Certain patients may benefit from voice therapy. Click here for more details on expected outcomes. Regarding the second case, the patient spoke phrases that accentuate the voice breaks. With other phrases, the vocal quality is very near normal. Samples can be heard here.

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Example 2: ABductor Spasmodic Dysphonia

Audio - Standard Passage

Note the sudden breathy voice breaks. The vocal cords come apart suddenly when they should not which causes a sudden breathy voice break. Patients generally have more difficulty with voiceless weighted sentences (ie, counting from 60 to 69) than voice weighted sentences (ie, counting from 80 to 89). For this disorder, BOTOX is injected into the posterior cricoarytenoid muscles. Click here for more details on expected outcomes. Here is a video of stroboscopy performed during phonation. Note that the voice is more fluent with voice weighted "eee" rather than the voiceless weighted "see".

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Example 3: Mixed Spasmodic Dysphonia

Audio - Standard Passage

Elements of both ADductor as well as ABductor spasmodic dysphonia is present. For this disorder, BOTOX is injected into both the posterior cricoarytenoid and thyroarytenoid muscles. Click here for more details on expected outcomes. Example provided courtesy of Dr. James Thomas.

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Example 4: Respiratory Spasmodic Dysphonia

Audio - Standard Passage

Respiratory spasmodic dysphonia is a rare type where spasms occur only on inspiration intermittently. For this disorder, BOTOX is injected into the thyroarytenoid muscles. First example provided courtesy of Dr. James Thomas.

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Example 5: Tremor

Audio - Standard Passage

videoClick here to view video.

This example was placed in this section as this type of voice may be mistaken for spasmodic dysphonia. However, it should not be mistaken for spasmodic dysphonia. Nor is it treated solely with BOTOX which only partially helps. In this case, the voice is actually due to a tremor that occurs only with vocalization. The tremor shakes the ENTIRE laryngopharyngeal complex resulting in the rhythmic voice shaking. As one can see, BOTOX injection to the vocal cords would not address the tremor of the pharynx resulting in persistent undulating voice quality. Medications that have helped (some) include primidone and inderal.

Read more about botox treatment for vocal tremor.

Muscle tension dysphonia is another disorder commonly and erroneously mistaken for spasmodic dysphonia.

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tremor

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How is BOTOX Injected into the Vocal Cords?

videoClick here to view video.

The video presented here was produced by my mentor, Dr. James Thomas, who has graciously allowed the video to be reproduced here. I perform BOTOX injections to the vocal cords for spasmodic dysphonia (and more rarely, in patients suffering from laryngospasm spells) in the same manner as shown in this video. Treatment expectations and other frequently asked questions can be found here. The steps are as follows:

  1. Numb the windpipe with 2% lidocaine. With injection, the patient coughs spraying the lidocaine throughout the airway. By doing this, the patient is much more comfortable in the following steps (no coughing, swallowing, etc).
  2. Next, under EMG guidance, the needle containing BOTOX is directed into the vocal cords. The needle is properly placed when the EMG emits a characteristic sound.
  3. The procedure is repeated to the opposite vocal cord. The one thing I do differently is that I use the same needle to inject the other side as I don't completely withdraw the needle.

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injection

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Here is a different YouTube video as well.

 


 

 

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