Joseph R. Anticaglia, MD
Medical Advisory Board
I think it’s “problematical for people to listen to me. I cannot listen to myself on TV. … I feel sorry for you guys having to listen to me,” said the presidential 2024 candidate Robert F. Kennedy, Jr. in his raspy voice in News Nation’s Town Hall meeting in Chicago on June 28, 2023. He acknowledged the challenge people have paying attention to a person’s halting, choking speech, struggling to finish a sentence. Kennedy said his raspy voice was due to “Spasmodic Dysphonia.”
Spasmodic dysphonia (SD) is a neurologic disorder that adversely affects the quality of a person’s voice. It causes involuntary contractions (spasms) in the muscles of the larynx (voice box) which most often result in a strained, shaky, or strangled-sounding voice. The condition can cause the person’s speech to be harsh, choppy with words cut off, or hesitant because of difficulty, to start a sentence. Less frequently the voice can have a breathy quality to it.
Spasmodic Dysphonia affects the muscles in the larynx causing them to go into involuntary spasm which changes the sound of a person’s voice. The voice can sound tight or strangled as if someone is choking you, or breathy as if you’re whispering. It can also sound choppy, broken, hoarse, or trembling. A team approach is best adopted to manage this condition.
SD is a lifelong disorder that doesn’t affect a person’s life expectancy. It most often happens in women between 30 and 50 years of age. The exact cause of SD is unknown. Researches are uncertain why the brain sends abnormal nerve signals to the muscles of the larynx causing them to spasm. However, they theorize that SD may be caused by an abnormality in the basal ganglia which is part of the brain that helps control muscle movements.
The symptoms vary widely in severity, develop over one to two years, and the disorder is not progressive. In general, laryngeal spasms do not occur when a person is crying, laughing, singing, shouting, or whispering. Stress can trigger the onset of SD.
The diagnosis is made by listening to the person, taking a medical history, physical examination, and ordering appropriates tests. An Otolaryngologist, Ear, Nose and Throat specialist. will visually examine the vocal folds, and make the diagnosis. A Speech-language pathologist can evaluate voice quality, and voice production. A Neurologist will search for an underlying neurological problem.
There are three types of SD, and any of the types can make your voice sound trembling, or shaky.
This is the most common type of SD accounting for approximately 90% of the cases. It happens when the muscles that bring the vocal folds together, and slam into spasm. The result is a voice that suddenly sounds full of effort, strained, tight and hoarse.
This is the second most common type of SD. It happens when the laryngeal muscles that pull the vocal folds apart during speech spasm. This makes your voice sound breathy, and weak.
This is a very rare type of SD combining both types of dysphonia.
There is no cure for spasmodic dysphonia. The goal is to reduce symptoms, and improve communication skills. A team approach is most advantageous. Botox injected directly into the affected muscles of the larynx by an Otolaryngologist has proved to be successful. The injections need to be repeated periodically. Speech-language pathologist have been helpful in improving a patient’s communicative skills. A Neurologist is a useful member of the team to rule out intracranial, and other pathology.
ADductor laryngeal muscles—Thyroarytenoid muscles, bring the vocal folds together.
ABductor laryngeal muscles—Posterior cricoarytenoid muscles, moves the vocal folds apart.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.
