Spasmodic Dysphonia.
What is Spasmodic Dysphonia?
This is a chronic neurological condition that occurs due to excessive secretion of neurotransmitter chemicals by the brain called acetylcholine. The body normally controls how much chemical is needed and once the required movement is completed the chemical seize to be released. In spasmodic dysphonia, the brain loose control of how much neurotransmitter is secreted in the vocal cords. This result into excessive contraction and spasm of the vocal cords that describe the symptoms of a spasmodic dysphonia. Other muscles of the body can be affected too causing excessive contraction of such muscle groups. This condition can sometimes be hereditary but usually presents from the 3rd decade of life onward.
What's the Cause?
There is no known cause for this chronic neurological disorder. 50% of people may relate this to a stressful time in life or following an upper respiratory tract infection.
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Is there a cure?
Unfortunately there is no cure for this condition. However most people leave a normal life with the current treatment available.
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What are the symptoms?
The symptoms depend on the type. There are two types of spasmodic dysphonia.
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Adductor Type
Adductor Spasmodic Dysphonia
This type of spasmodic dysphonia is due to excessive spasm of the muscles that closes the vocal cords during phonation (sound production by the vocal cords). This contraction gives the characteristic tightness, strangled and breaks quality to the voice during speech. This is the most common of the two and must easier to treat.
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Abductor Type
Abductor Spasmodic Dysphonia
This type of spasmodic dysphonia is due to excessive contraction of muscles that opens the vocal cord during breathing and speech hence the typical breathiness and whispery quality to the voice.
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How do you diagnose Spasmodic Dysphonia?
This condition is diagnosed by an expert ENT doctor who specializes in dealing with voice disorders (Phonosurgeon or laryngologist) who will listen and examining your voice box. A speech and language therapist can also diagnose this. You will need an endoscopic examination of the vocal cords. Also a stroboscopy may be needed to exclude other disorders of the vocal cords.
What is the treatment for Spasmodic Dysphonia?
The Gold standard treatment is botox injection into the affected muscles of the vocal cords. The botox is injected using a special needle into the contracting muscles of the vocal cord. This can be injected in the clinic using an Electromyography (EMG) guide or in the operating theatre under a general anaesthesia. Most often this injection is performed in the clinic lying on a couch.
Do I need special preperation?
There is no special preparation before the injection.
What happens after the injection?
The injection takes only less than 5 minutes. You can continue with your daily activity after the injection. Your voice will go quieter in the first week or more after the injection. Your voice will be expected to improve and get strong for 3 months before the botox wears off.
Will I need a repeat injection?
Yes. Botox wears of after 3-4 months and you may need further injection every 3-4 months.
Are there any other treatments for Spasmodic Dysphonia?
Yes. Speech therapy may help minimized the symptoms of spasmodic dysphonia. Some sedative tables may be use but the side effects of sedation may prevent you using it.
Surgery for Spasmodic Dysphonia?
Surgery may have a place in the treatment of spasmodic dysphonia. The outcome is variable and the symptoms may still recur. However, the long-term outcome of surgery for spasmodic dysphonia is promising. Examples of surgery for spasmodic dysphonia are laser thyroarytenoid myoneurectomy, thyroplasty, selective resection of recurrent laryngeal nerve.
