Spasmodic Dysphonia Treatment

I.) Voice Disorder

A.) Voice Disorder Definition:

1a.) A Disorder characterized by inappropriate pitch (too high, too low, never changed, or interrupted by breaks); loudness (too loud or not loud enough); or quality (harsh, hoarse, breathy, or nasal)

(American Speech-Language-Hearing Association)

2a.) A voice disorder, dysphonia, is a phonatory (laryngeal tone) production and/or resonance (quality) difference of sufficient degree to call attention to itself, interfere with communication, or create a negative self-perception on the part of the speaker. (Palmer, John M., & Yantis, P. A. 1990)

B.) Types of Voice Disorders

(Voice Disorders fall into three main categories)

1b.) Organic: Organic Voice Disorders are those that do have a known cause.

2b.) Structural: Structural disorders are caused by some lesion (physical abnormality) of larynx. They consist of Contact Ulcers, Cysts, Granuloma, Hemorrhage, Hyperkeratosis, Laryngitis, Leukoplakia, Nodules, Papilloma, Polyps, Trauma,

3b.) Neurogenic: Neurogenic Voice Disorders are caused by some problem in the nervous system as it interacts with the larynx. They consist of Paralysis/Paresis, Spasmodic Dysphonia, and Tremor.

2.) Functional: Functional disorders encompass all disorders that result in physical change, but do not have a known cause. They are hyper functional voice disorder (abuse or misuse,) and are caused by poor muscle functioning. They consist of Muscle tension dysphonia, Anterior-Posterior Constriction, HyperABduction, HyperADduction, Pharyngeal Constriction, Ventricular Phonation, Vocal fold bowing. (Mckibbin, C. R., C,. Hedge, M. N. 2006)

3.) Psychogenic: Psychogenic disorders exist because it is possible for the voice to be disturbed for psychological reasons. In this case, there is no structural reason for the voice disorder, and there may or may not be some pattern of muscle tension. They consist of Conversion dysphonia or Aphonia and Puberphonia (Mutational Falsetto)

II.) Spasmodic Dysphonia

A.) What is Spasmodic Dysphonia?

Spasmodic Dysphonia (SD) is most often a sequela of focal laryngeal dystonia. The cause is unknown and the disorder is characterized by abnormal involuntary movements of the vocal folds, resulting in breaks in speech fluency. In some patients there may be a strong psychogenic contribution to these disabling symptoms. Dworkin, J. P., & Meleca, R. J.1997)

B.) Types of Spasmodic Dysphonia

1b.) Adductor Spasmodic Dysphonia (AD-SD)

Is a focal movement disorder of the larynx with overadduction of the folds for a brief period of time at irregular intervals of speech and has been attributed to organic pathology of the central and peripheral nervous systems. (Sapienza, Murray, and Brown, 1998)

Symptoms include strain, struggle and intermittent voice breaks during vowels or the consistent perception of an effortful, harsh voice. Some hypotheses concerning the etiology of (AD-SD) have been:

* Myelinization abnormalities of the laryngeal nerve

* Abnormal brain stem responses indicative of variable cranial nerve involvement.

* Extrapyramidal lesion in the C.N.S.

(Andres, Moya A. 1999)

2b.) Abductor Spasmodic Dysphonia (AB-SD)

This less common form of SD causes the posterior cricoarytenoid muscle to contract suddenly, causing the vocal folds to pull apart suddenly. There are intermittent episodes of breathy dysphonia, drops in pitch, and vowel prolongations. (Merson and Ginsberg, 1979)

3b.) Mixed abductor-adductor Spasmodic Dysphonia:

Is characterized by both abductor and adductor laryngospasms. Perceptually, there are aphonic, breathy periods as well as strained voice arrests. Connito and Johnson (1981) believe that there may be a continuum of spasmodic dysphonia rather than separate symptoms.

C.) Who is affected by Spasmodic Dysphonia?

Spasmodic Dysphonia can affect anyone. The first signs of this disorder are found most often in individuals between 30 and 50 years of age. More women appear to be affected by spasmodic dysphonia than are men. (Bethesda, MD 2002)

D.) What causes Spasmodic Dysphonia?

The exact etiology of spasmodic dysphonia is unknown, is not caused by stress or psychological disorder. It is thought that spasmodic dysphonia is due to abnormal functioning in an area of the brain called the basal ganglia (help to coordinate movements of the muscles throughout the body). (Deem. F. J., & Miller, J. 2000)

E.) Spasmodic Dysphonia Diagnosis

Most people are evaluated by a team that usually includes:

1e.) Otolaryngologist: Examines the vocal folds to look for possible causes for the voice disorder. Fiberoptic nasolaryngoscopy, a method whereby a small lighted tube is passed through the nose and into the throat, is a helpful tool that allows vocal cord movement during speech.

2e.) Speech language pathologist: Evaluates the patient's voice and voice quality.

3e.) Neurologist: Evaluates the patient for signs of muscle movement disorders.

(NIDCD 2007)

III.) Spasmodic Dysphonia Treatment

(Controversy rages about the etiology of this puzzling condition, as well as about its treatment. There is presently no cure for spasmodic dysphonia. )

A.) Adductor Spasmodic Dysphonia (AD-SD) Treatment

1a.) Voice therapy doesn't seem to help chronic cases. However, adopting a breathy voice (to keep folds from touching) and rate, phrasing changes techniques.

2a.) There is a significant voice improvement following XYLOCAINE injection to anesthetize the recurrent laryngeal nerve and mimic unilateral vocal fold paralysis. (Andres, Moya A. 1999)

B.) Abductor Spasmodic Dysphonia (AB-SD) Treatment

1b.) ABSD is related to vocal hyperfunction. If hyperfunctional behaviors are identified and reduced, the phonation breaks are usually minimized. (Boone, D. R., & Mcfarlane, S. C. 1988).

2b.)