Judy Rodman - All Things Vocal Blog

Training & insights for stage and studio singers, speakers, vocal coaches and producers from professional vocal coach and author of "Power, Path & Performance" vocal training method.

Monday, June 22, 2009

Spasmotic Dysphonia: Causes and Diagnosis

So how do you get spasmodic dysphonia? How is it even diagnosed? There are currently unsolved mysteries in the answers to both these questions.

WHAT CAUSES SPASMODIC DYSPHONIA?


Here's the current state of research... no one really knows for sure. Somehow improper and inappropriate signals are sent from the brain to the vocal cords that produce spasms of the muscles controlling the vocal cords. Estimates are that 5 in 100,000 people are affected, twice as many women as men. Onset it usually mid 30's to 50's, but can begin in teens.

Sometimes the onset occurs after a viral illness or psychological trauma, sometimes after some kind of physical vocal damage. Sometimes the person has been poisoned by taking a medication or being exposed to heavy metals. Sometimes there is family history of some kind of dystonia, or muscle spasm disorder. And sometimes it seems to come out of thin air, someone just wakes up one day and the voice has a strange uncontrollable sound to it. And sometimes the voice is normal!

What is known is that SD is exacerbated by stress, fatigue, pressure and tension. An SLP at the symposium explained it to me like this: the threshold for vocal dysfunction is much lower in SD patients, and the stress that can trigger a worsening of the symptoms can be mild. There is usually gradual onset, it gets worse, then levels off.

HOW IS SPASMOTIC DYSPHONIA DIAGNOSED?

Many times the voice disorder called Spasmodic Dysphonia is ignored until it interferes with a person's lifestyle or employment. Often the first help sought will be from a vocal coach. That's a huge reason for all vocal coaches to be familiar with SD.

The presenting symptoms occur with the SPEAKING VOICE! If the speaking voice is fine, spasmodic dysphonia is extremely unlikely to be a problem, in fact I would dismiss the possibility outright, and suggest re-training the singing voice which is likely to have problems with "muscle tension dysphonia" (MTD) instead. IMPORTANT: if vocal lessons and re-training does NOT result in quick progress, the presence of SD should be considered.

Symptoms run the gamut:
  • You have trouble speaking, sounding chronically hoarse.
  • You are frequently asked if something's wrong with your voice.
  • Your speaking voice sounds tight, strained, strangled, breathy or whispery.
  • Spasms in your larynx often interrupt sound, causing words and sentences to be broken up.
  • But...breathing and swallowing feel normal.
Here is a video illustrating the sound of a voice plagued with variations of spasmotic dysphonia. Here are some audio file illustrations from a different source.

Getting an accurate diagnosis of SD is difficult. It can take months o r at least weeks to get a definitive diagnosis, because the symptoms of SD and MTD are very similar, and other vocal issues must be ruled out. Diagnosis IS important, however, because treatment is different and must be tailored to the disorder, or the combinations as listed in my previous post defining SD and its various types.

What to do if you suspect spasmodic dysphonia or any other voice disorder? If in doubt, get checked out- by a medical team expertly familiar with SD such as the Vanderbilt Voice Center. As vocal coaches, choir directors and drama teachers, if we suspect a physiological or neurological disorder like SD, we should always suggest a medical examination.

At your check up, you will have your vocal cords "scoped" to see if there is any physical problems that can be found in your larynx. You will be asked, probably by a speech language pathologist (SLP) in the medical team to speak certain phrases such as
  • "Aaron eats apples & oranges",
  • Help me hold this hoop, pet the pound puppy"
  • and sustain certain vowel sounds like "ee" and "ah", among other speaking and singing tasks.
But there is no brain scan or blood test for definitively identifying this disorder. The two evidences most relied upon for diagnosis of true spasmodic dysphonia are -
  1. ...the sound of the voice (vocal nuances can tell an experienced clinician with a good ear whether or not to suspect SD)
  2. ...and whether or not a round of speech therapy and/or vocal training will work. The experts at the SD symposium suggest that if re-training offers limited or no success, the problem must originate in the wiring of the brain, possibly the basal ganglia, which cannot be re-trained. I will discuss this theory as well as report on alternate theories in my next post about treatment options for SD patients.
After various stages of testing, treatment options for spasmodic dysphonia are offered. I'll discuss these in my next post.

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