Age-related voice changes
Arytenoid repositioning surgery
Cancer of the larynx
CT or MRI of neck and or chest
Dilation of airway stenosis
Endoscopic cricopharyngeal myotomy
Endoscopic Zenker’s diverticulotomy
Flexible Endoscopic Evaluation of Swallowing
In-office laryngeal biopsy
In-office steroid injections of some laryngeal lesions or scarring
In-office vocal fold injection augmentation
Laser treatment of papillomas and other vocal fold lesions
Modified Barium Swallow Study
Paradoxical Vocal Fold Motion and Laryngospasm
Radiation-related swallowing disorders
Reinnervation of the paralyzed vocal fold
Spasmodic dysphonia, also called laryngeal dystonia, is a voice disorder characterized by involuntary spasms or movements in the muscles of the larynx, which causes the voice to break, and have a tight, strained, or strangled sound. It most often affects women, particularly between the ages of 30 and 50. The cause of spasmodic dysphonia is not known, but most cases are believed to be caused by a nervous system disorder and may occur with other movement disorders.
There are three main types of spasmodic dysphonia:
Adductor spasmodic dysphonia: Characterized by sudden involuntary spasms that cause the vocal cords to close and stiffen. The spasms interfere with vibration of the vocal cords and production of sound is difficult. Stress can make spasms more severe. Speech sounds are strained and full of effort. Spasms do not occur when whispering, laughing, singing, speaking at a high pitch, or speaking while breathing in.
Abductor spasmodic dysphonia: Characterized by sudden involuntary spasms that cause the vocal cords to open. Vibration cannot occur when cords are open so production of sound is difficult. Also, the open position allows air to escape during speech. Speech sounds are weak, quiet, and whispery. Spasms do not occur when laughing or singing.
Mixed spasmodic dysphonia: Characterized by symptoms of both adductor and abductor spasmodic dysphonia.
These 3 types can occur with or without tremor.
Spasmodic dysphonia treatment is be determined by your physician based on a patient’s age, overall health, medical history, extent of the disease, tolerance for specific medications, procedures, or therapies, expectations for the course of the disease, and opinion or preference. The goal of treatment is to reduce symptoms of the disorder. Periodic botulinum toxin injections to one or both vocal cords can often relieve symptoms.
More information and resources for Spasmodic Dysphonia can be found at the National Spasmodic Dysphonia Association website: http://www.dysphonia.org/
Transcervical cricopharyngeal myotomy
Transcervical treatment of Zenker’s diverticulum
Vocal fold hemorrhage
Vocal fold paresis/paralysis
Normally the vocal folds move symmetrically, opening or separating with inspiration and closing or coming together with talking or coughing. These movements are controlled by the recurrent laryngeal nerve on each side of the larynx. Vocal fold paresis or paralysis is caused by damage or injury to the neurologic input to the larynx.
Unilateral: If one of the vocal folds does not move appropriately it can cause hoarseness with a breathy voice. This is when the vocal folds do not come all the way together to vibrate against each other resulting in a gap or space between the vocal folds. This space between the vocal folds can be closed through both temporary and permanent treatment options including vocal fold injection augmentation, medialization thyroplasty, laryngeal reinnervation, and arytenoid repositioning surgeries.
Bilateral: If both of the vocal folds do not move appropriately, a patient may have difficulty breathing from the vocal folds not being open enough, or hoarseness if the vocal folds are not close enough together. In some cases, patients require a tracheostomy to breath comfortably. While procedures can be done to both improve the voice or the airway in the setting of bilateral vocal fold paralysis, it is a balance between breathing and talking. If breathing improves, generally the voice worsens, and the risk of difficulty swallowing increases. If the voice improves, breathing may become more difficult.