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.
Watch the video clip shown in this blog (same as this article, but video was not able to be uploaded here). 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.
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.
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.
The film “The King’s Speech,” nominated for Oscars in 12 categories for the 83rd Annual Academy Awards hits home for many who suffer from stuttering. However, I am sure this story also has empathetically affected those patients who suffer from spasmodic dysphonia.
Think of it as stuttering of the voicebox where the words get stuck in the throat level rather than the mouth level.
Both conditions result in patients severely limiting their social engagements and cause tremendous stress when communicating with others.
Many people know what stuttering sounds like… Now listen to what spasmodic dysphonia sounds like here in this video. This video also shows how spasmodic dysphonia is treated with botox injections to the vocal cord. Such injections calm the spasms down so that the person is able to speak almost completely normally for at least 3 months until the botox wears off and it needs to be repeated.
The NYT wrote a somewhat humorous article on Oct 7, 2010 regarding botox injections for wrinkles from both a supply (physician) and demand (patient) viewpoint.
In NYC, one can now find neon colored signs advertising botox specials!
Of note, our clinic performs botox injections not for just cosmetic reasons (wrinkles), but also medical reasons including migraine headaches, TMJ, spasmodic dysphonia, torticollis, etc.
The Culpeper Star Exponent released a story on Sept 27, 2010 regarding an individual suffering from ABductor spasmodic dysphonia. This voice disorder is characterized by voice breaks while talking making it very difficult to talk as well as to be understood.
This individual has been treated with botox injections by Dr. Chang who was mentioned in the article:
“Taylor has one of the rarest forms of the disorder and therefore the hardest to treat. Nonetheless, she seeks treatment every four months through Dr. Christopher Chang, an ear, nose and throat specialist based in Warrenton. He is a leading expert in vocal chord treatments, and Taylor is happy he’s located so close by.”
Introduction Spasmodic dysphonia is a dystonia (muscle spasms) involving the muscles of the voicebox resulting in involuntary attacks of a strangled sounding voice. Treatment is botox injection to the involved muscles resulting in a decrease of such spasms thereby resulting in a more smooth-sounding voice.
Unfortunately, there are side effects with botox injections to the voicebox including aspiration, dysphagia, breathy voice, etc for a short period of time prior to the good voice. Typically, one week of side effects results in about 3 months of a good voice.
Research into this area typically has been to try and maximize the duration of a good voice while decreasing the duration of side effects.
A prior paper published by Dr. Chang tried to establish what the correct dose is to maximize a good voice and minimize side effects.
This book chapter tries to determine if age influences botox response.
Age and Botox Responses
What was found is a positive correlation between age and duration of normal voice and duration of side effects after botox injection. Age did not appear to play a role in the severity of side effects experienced by patients. However, the number of BTX-A injections received by a given patient was negatively correlated with duration of normal voice and side effects to a degree greater than age.
What does this mean?
Age must be taken into consideration when deciding on what dose of botox to inject since as a patient becomes older, one may see a slow increase in not only duration of normal voice, but also duration of side effects reported. Stated another way, for a given dose, the duration of side effects is larger for an older patient compared with a younger one. However, as the cumulative number of injections a patient receives increases over time, the duration of normal voice and side effects would be expected to decrease slowly.
CHAPTER 1: Psychogenic Voice Disorders by Grace W. Johnson, Carmen T. Gonzalez, Christopher Y. Chang, Sarah L. Maines, Melissa M. Mainville, Amy J. Asbury (Download Chapter Here)
and
CHAPTER 6: Age as a Factor in Responses to Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients
by Christopher Y. Chang, Peter Chabot, James P. Thomas, MD (Download Chapter Here)
This textbook is currently at press and anticipated to be released for purchase before the end of 2010. You can purchase it here.
Dr. Chris Chang has co-authored two book chapters in a soon to be published hardcover textbook entitled “Laryngeal Diseases: Symptoms, Diagnosis and Treatments“. The book chapters Dr. Chang has co-authored are entitled:
Psychogenic Voice Disorders
by Grace W. Johnson, Carmen T. Gonzalez, Christopher Y. Chang, Sarah L. Maines, Melissa M. Mainville, Amy J. Asbury
and
Age as a Factor in Responses to Botulinum Toxin Injection in Adductor Spasmodic Dysphonia Patients
by Christopher Y. Chang, Peter Chabot, James P. Thomas, MD
This textbook is currently at press and anticipated to be released for purchase before the end of 2010. You can purchase it here.
Dr. Chang will be a guest lecturer for the Northern Virginia Spasmodic Dysphonia Support Group. The lecture will be held on October 20, 2010 from 7-9PM at INOVA Fair Oaks Campus, Medical Plaza Building, Conference Room A. The lecture topic is on Spasmodic Dysphonia, a laryngeal dystonia that results in altered vocal quality due to involuntary muscular spasms of the voicebox.
The support group leader is Paula Cooper (Email: paulakcooper2004@yahoo.com).
Dr. Chang provides botox injections for spasmodic dysphonia every Friday afternoon.
