neurogenic voice disorders

Spasmodic dysphonia

• form of focal laryngeal dystonia

• Moves no rhythmic / unpredictable ways

General characteristics of spasmodic dysphonia

Adductor-type

• VF spasm shut with tight voice breaks/spasms during voicing

• Strained and strangled voicing ( goes to use voice then spams)

Abductor-type

• VFs spam open with breathy voice breaks during voicing tasks

• Excessively breathy, irregular voice

• VF fighting closure

Spasmodic dysphonia - onset of symptoms

• upper respiratory infection, laryngeal injury or emotional stress

• Worse when stressed or tired ( typical of any neurological disorder

• Pts with heavier vocal demands - many dystonias are thought to be use-dependent

• Age 30-50, 80% of women

• Gradual onset with mild symptoms initially

• Progression of symptoms over 1-2 years then remain chronic - moderate to severe

Perceptual characteristics of spasmodic dysphonia

• affects voluntary laryngeal activity specific to speech

  • Emotion-related voicing unaffected laughing

  • Non-speech laryngeal task ( coughing, whistling) unaffected

  • Whispering unaffected

• Hyperfunctional voicing patterns may develop over time as patient reacts to SD → SD + MTD

• May co-occur with vocal tremor

  • Treatment Botox address the SD but may not help the tremor

Adductor spasmodic dysphonia

• effortful speech voice production described as a strained-strangled voice quality

• Intermittent voice stoppages/breaks during vowel productions within connected speech

• Liquids and nasals

• Voice stppages associated with overclosure of the vocal folds

• Normal cough and laughter ( intact emotion vocalization from PAG) singing and emotion shouting relatively spared