Dr (Prof.), Vinay Goyal, AIIMS, New Delhi
What is spasmodic Dysphonia?
Spasmodic dysphonia (SD) is talk specific Dystonia involving apparatus of voice
production especially vocal cords.
SD is mainly of two types.
Adductor SD in which vocal cords come close while speaking leading to strangulated, strained effortful voice which may be associated with voice tremor. Voice quality can be examined while speaking "eeeee"
Abductor SD in which vocal cords separates excessively while speaking leading to hollow, breathy, low volume voice. Voice quality can be examined while speaking "hahahaha".
What are risk factor for SD?
Risk factors for developing Adductor SD is voice abuse, especially in
persons in profession of speaking in excess/loud like singers, teachers, etc.
How to diagnose SD?
First, clinical presentation with change in voice should suspect SD. It is mandatory to exclude local problem in throat, by examination by ENT surgeon to exclude pathology mimicking SD like vocal nodule, etc.
How to treat SD?
1. Avoid risk factors
2. Medical drugs used to treat dystonia
3. Botulinum toxin: This is most promising treatment of SD. Patients are injected with Botulinum toxin in to the vocal cords. Effect comes in 1-2 weeks and may last up to 6 months. Common complications are: reduction in volume of voice, cough, mild aspiration, mild difficulty in swallowing, etc