Respiratory Spasmodic Dysphonia

Respiratory spasmodic dysphonia is one of the most rare subtypes of a class of laryngeal dystonia collectively known as spasmodic dysphonia. It is also known more accurately as laryngeal adductor breathing dystonia or respiratory spasmodic dystonia or respiratory laryngeal dystonia.

Introduction

Spasmodic dysphonia is a type of dystonia in which there are involuntary muscle spasms or contractions of the muscles involved in voice production. This disorder is similar to the involuntary eyelid twitches of blepharospasm. Spasmodic dysphonia should not be, but is often confused with muscle tension dysphonia or tremor. There are 2 main types of spasmodic dysphonia: ABductor and ADductor. Other much more rare types include mixed and respiratory.

ADductor dysphonia is when the vocal cords comes together suddenly while talking resulting in voice stops and effortful speech. Often, the voice chokes off. Counting from 80 to 89 is harder than counting from 60 to 69. Stressful situations often exacerbate the condition. ABductor dysphonia is when the vocal cords suddenly moves apart while talking resulting in loss of voice (breathy). These patients find counting from 60 to 69 harder than counting from 80 to 89. ABductor dysphonia is not as common as ADductor dysphonia.

Respiratory Spasmodic Dysphonia

Respiratory spasmodic dysphonia is when the vocal cords come together suddenly when inhaling. So the voice actually sounds quite normal... until the patient takes a breath in. During such inhalation, one can hear an audible choking sound.

A brief word about nomenclature. "Dysphonia" means hoarseness. As such, the term respiratory spasmodic dysphonia is not accurate. Rather, "dystonia" should be used instead which is defined as an abnormal muscle contraction.

In the video clip shown above, in the first half of the video, listen to the audio of a patient suffering from respiratory spasmodic dystonia talking. The latter half is a video of the patient's voicebox while vocalizing. Note that the vocal cords intermittently do not move apart when she is taking a breath in. Normally with breathing, the vocal cords should move apart to allow air to pass between the vocal cords.

Treatment

Treatment is the same as for ADductor spasmodic dysphonia. Botox is injected into the vocal cords which reduces the spasms when she takes a breath in.

Watch a video of botox being injected.

Click here to read more about spasmodic dysphonia.

Dr. Chang performs botox injections for this disorder every Friday afternoon.

Speech Therapy Found to be of NO Benefit for Spasmodic Dysphonia

A recent study was published that has found that speech therapy had minimal if any significant beneficial effect on spasmodic dysphonia (a spastic vocal disorder) in a study cohort of 31 patients.

The study was divided in 3 patient treatment groups:

- One-third received no further intervention after botox injection which is considered standard of care in the treatment of spasmodic dysphonia
- One-third received a standard 5-week course of voice therapy after botox injection
- One-third received a 5-week course of sham voice therapy after botox injection

All patients regardless of treatment group experienced improved voice quality in response to botox injection.

However, patients who received voice therapy after botox injection did not experience longer injection effect duration or significantly greater improvements in vocal quality than patients in botox only or botox plus sham therapy groups.

Dr. Chang performs botox injections for spasmodic dysphonia every Friday afternoon.

Reference:
Combined Modality Treatment of Adductor Spasmodic Dysphonia. J Voice. 2011 Feb 2. [Epub ahead of print]

Dr. Chang to Give Lecture on Spasmodic Dysphonia in Richmond, VA

Dr. Christopher Chang will be a guest lecturer on the topic of spasmodic dysphonia in Richmond, VA on June 11, 2011. Dr. Chang was invited to give a 3 hour long talk to the Central Virginia SD Group at the CJW Medical Center Johnston-Willis Campus in the Board Room starting at 12PM.

Dr. Chang is a Yale and Duke trained, board-certified otolaryngology-head and neck surgeon with fellowship training in laryngology. He is considered an expert on spasmodic dysphonia and has patients coming from as far as the Philippines (yes... the one on the other side of the world) every 3-6 months to receive treatment for this rare condition.

Read more about this condition here.

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Books on voice therapy that MIGHT be a useful ADJUNCT to botox injections: