Neurological Concomitants in Spasmodic Dysphonia
By Lyn Dee Harrelson


There are no specific guidelines to identify what people perceive as a normal voice. In some cases, a therapist may consider a person's voice to be abnormal, while the client feel the voice is normal. While the reverse may happen when the client feel the voice quality is not adequate, but he therapist feel that it is. Robyn Mundy, in his article Mislaid Voices featured in the March 1999 NSDA Newsletter, made a good point when he reported that although SD does not impact the function of the brain in relation to intellect, personality, memory, emotion, sight or hearing, but it [SD] can have a profound influence on social and professional interaction as well as emotional well-being. In identifying true SD as an organic disorder associated with malfunction of the basal ganglia, it is important to remember that SD is not a curable disorder with the current treatment options available today. There are three different treatment options used today surgical, medical, and behavioral.

Nerve resection
Resection of the recurrent laryngeal nerve was the most common treatment for SD up until the 1980's. This procedure consists of the recurrent laryngeal nerve. This is a permanent condition that eliminates all impulses to the intrinsic muscles of the larynx.

Other resources for information:

DMRF: Surgery

Botox Injection
Botulinum toxin is inserted into the hyperfunctioning laryngeal muscle. This provides temporary relief of laryngeal spasms. The Botulinum acts as a barrier at the level of the motor end plate and blocks the passage of the signals from the brain that trigger the movement of the hyperactive laryngeal muscle. The effects of this toxin usually last anywhere from four to six months.
Some adverse effects are:

Difficulty swallowing
Periods of breathiness in voice
Inevitable deterioration of normal voice characteristics

Other less effective medications prescribed are:

Muscle relaxants

Other sources of information:

DMRF: Treatment Options

CSOM: Treating Spasmodic Dysphonia with Acupuncture



Voice Therapy
Although with true SD, voice therapy cannot cure the spastic characteristics of the laryngeal muscles, it can provide relief from the symptoms. Voice therapy offers the client options for dealing with laryngeal spasms. Relaxation techniques help to make the person more aware of how they are reacting to the way they speak and help them to reduce excess tension. Therapy also provides education about the laryngeal anatomy and as well as identifying some environmental factors that might trigger increase spastic activity. By incorporating a behavioral therapy component into whatever treatment technique chosen, the client is more likely to achieve more success with speaking. Behavioral intervention is less invasive than alternative treatments for SD. By allowing behavioral intervention the opportunity to work does not hinder any other optional treatment such as laryngeal nerve resection or Botox injection. Behavioral intervention is necessary for treatment of patients with SD.

Emotional Component
This is an important component to remember when dealing with a person with SD. These people are trying to deal with a permanent voice characteristic that is not their own. In all daily activities they are reminded that their voice is different and draws attention. It distorts how people look at them and has an impact on their life and how they live it. Along with treating the symptoms of SD, remember to address these people's feelings and educate them as best as possible on how to deal with this disorder in their everyday life.

Additional Resources for information:

DMRF: Complementary Therapy

Spasmodic Dysphonia Bulletin Board

Spasmodic Dysphonia Neurological Concomitants Differential Diagnosis Treatment Links