Symptoms of Spasmodic Dysphonia

Key Glossary Terms

Spasmodic Dysphonia (SD)
A voice disorder resulting from involuntary movements (spasms) of the voice box muscles

Dystonia
A nervous system problem that causes involuntary movement; dystonia is not a psychological problem; SD is a type of dystonia

Adductor SD (Ad-SD)
Spasms in muscles that close vocal folds, which interrupt speech and cause strained or strangled voice breaks

Abductor SD (Ab-SD)
Spasms in muscles that open vocal folds, which interrupt speech and cause breathy or soundless voice breaks

Glossary

Spasms of the vocal folds cause the typical voice changes of SD – a strained strangled voice for Ad-SD, and breathy voice or soundless breaks in Ab-SD. These are represented below.

• "Smooth" movement of voice box muscles
• Fluid voice

• "Closure type": vocal folds come together with too much force, interrupting speech
• Strained, strangled voice

• "Open type": Vocal folds move apart, interrupting speech
• Breathy voice or soundless breaks in voice

Patients with mixed SD have voice changes typical of adductor SD and abductor SD.

• There is no characteristic voice sound for mixed SD, but a careful evaluation of the voice will identify both the strained, strangled voice characteristics of adductor SD and the breathy voice or soundless voice breaks of abductor SD.

• The severity of the symptoms usually varies from day to day – and even over the course of a single day.
• Voice may sometimes be normal, abnormal at other times.

• Anxiety or fatigue makes symptoms more noticeable.
• Speaking to strangers, public speaking, and speaking in unaccustomed situations often make symptoms worse, probably because all of these situations increase anxiety.

• Most people with SD report that using the telephone is especially difficult.

• Symptoms are usually mildest in familiar situations.
• A glass of wine or beer can improve symptoms.

SD, like most focal dystonias, is task-specific. Voice problems occur only during specific voice tasks.

• In the case of SD, conversational speech is usually affected.
• The singing voice may remain normal.

• Sometimes symptoms will disappear in highly emotional situations, such as when the affected person is extremely upset, angry, or laughing.
• Swallowing and breathing, the other important functions of the larynx, are almost never affected.