Spasmodic Dysphonia

  • Jerome S. Schwartz
  • Phillip Song
  • Andrew Blitzer


Spasmodic dysphonia (SD) is a focal laryngeal dystonia characterized by involuntary, action-induced spasms of the muscles controlling vocal fold motion. The laryngeal adductor muscles (lateral cricoarytenoid [LCA], interarytenoid, and possibly the cricothyroid and thyroarytenoid [TA]), abductor muscle (posterior cricoarytenoid [PCA]), or rarely both groups of muscles may be affected. Adductor SD is characterized by a harsh, strangled, or effortful voice (glottal fry) with irregular phonatory breaks secondary to vocal fold hyperadduction or spasm. The supraglottic structures may be hyperfunctional as well. Abductor SD presents as a breathy, effortful, hypophonic voice with irregular breaks following consonant voicing secondary to vocal fold hyperabduction. Although the exact etiology of SD is unclear, SD is now recognized as a neurological disorder of central processing.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Blitzer A, Brin MF. Laryngeal dystonia: a series with botulinum toxin therapy. Ann Otol Rhinol Laryngol 1991;100:85–89.PubMedGoogle Scholar
  2. 2.
    Marsden CD, Sheehy MR Spastic dysphonia, Meige disease and torsion dystonia. Neurology 1982;32:1202–1203.PubMedGoogle Scholar
  3. 3.
    Stacy M, Jankovic J. Differential diagnosis and treatment of childhood dystonia. Pediatr Ann 1993;22:353–358.Google Scholar
  4. 4.
    Jankovic J. Movement disorders. In: Goetz CG, ed. Textbook of Clinical Neurology, 2nd ed. Philadelphia: Saunders; 2003, pp. 725–727.Google Scholar
  5. 5.
    Heaver L. Spastic dysphonia: a psychosomatic voice disorder. In: Barbara DA, ed. Psychological and Psychiatric Aspects of Speech and Hearing. Springfield, IL: Charles C. Thomas; 1960, pp. 250–253.Google Scholar
  6. 6.
    Traube L. Zur Lehre von den larynxaffectionen beim ileotyphus. Verlag Van August Hisschwald: Berlin; 1871, pp. 674–678.Google Scholar
  7. 7.
    Critchley, M. Spastic dysphonia “inspiratory speech.” Brain 1939;62:96–103.CrossRefGoogle Scholar
  8. 8.
    Aronson AE, Brown JR, Litin EM, Pearson JS. Spastic dysphonia. I. Voice, neurologic and psychiatric aspects. J Speech Hear Disord 1968;33:203–218.PubMedGoogle Scholar
  9. 9.
    Dedo HH. Recurrent laryngeal nerve section for spastic dysphonia. Ann Otol Rhinol Laryngol 1976;85:451–459.PubMedGoogle Scholar
  10. 10.
    Castelon Konkiewitz E, Trender-Gerhard I, Kamm C, et al. Service-based survey of dystonia in Munich. Neuroepidemiology 2002;21:202–206.PubMedCrossRefGoogle Scholar
  11. 11.
    Nutt JG, Muenter MD, Aronson A, et al. Epidemiology of focal and generalized dystonia in Rochester, Minnesota. Mov Disord 1988;3:188–194.PubMedCrossRefGoogle Scholar
  12. 12.
    Le KD, Nilsen B, Dietrichs E. Prevalence of primary focal and segmental dystonia in Oslo. Neurology 2003;61:1294–1296.PubMedGoogle Scholar
  13. 13.
    Pekmezovic T, Ivanovic N, Svetel M, et al. Prevalence of primary late-onset focal dystonia in the Belgrade population. Mov Disord 2003;18:1389–1392.PubMedCrossRefGoogle Scholar
  14. 14.
    Schweinfurth JM, Billante M, Courey MS. Risk factors and demographics in patients with spasmodic dysphonia. Laryngoscope 2002;112:220–223.PubMedCrossRefGoogle Scholar
  15. 15.
    Brin MF, Fahn S, Blitzer A, et al. Movement disorders of the larynx. In: Blitzer A, Brin MF, Sasaki CT, Fahn S, Harris K, eds. Neurological Disorders of the Larynx. New York: Thieme; 1992, pp. 240–248. 121Google Scholar
  16. 16.
    Greene P, Kang UJ, Fahn S. Spread of symptoms in idiopathic torsion dystonia. Mov Disord 1995;10:143–152.PubMedCrossRefGoogle Scholar
  17. 17.
    Blitzer A, Brin MF, Stewart CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 1998; 108:1435–1441.PubMedCrossRefGoogle Scholar
  18. 18.
    Jurgens U. Neural pathways underlying vocal control. Neuroscience Biobehav Rev 2002;26: 235–258.CrossRefGoogle Scholar
  19. 19.
    Simyon K, Jurgens U. Cortico-cortical projections of the motorcortical larynx area in the rhesus monkey. Brain Res2002;949:23–31.CrossRefGoogle Scholar
  20. 20.
    Simonyan K, Jurgens U. Efferent subcortical projections of the laryngeal motorcortex in the rhesus monkey. Brain Res 2003;974:43–59.PubMedCrossRefGoogle Scholar
  21. 21.
    Sessle BJ. Excitatory and inhibitory inputs to single neurons in the solitary tract nucleus and adjacent reticular formation. Brain Res 1973;53:333–342.PubMedCrossRefGoogle Scholar
  22. 22.
    Ludlow CL, Schulz GM, Yamashita T, et al. Abnormalities in long latency responses to superior laryngeal nerve stimulation in adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol 1995; 104:928–935.PubMedGoogle Scholar
  23. 23.
    Deleyiannis FW, Gillespie M, Bielamowicz S, et al. Laryngeal long latency response conditioning in abductor spasmodic dysphonia. Ann Otol Rhinol Laryngol 1999;108:612–619.PubMedGoogle Scholar
  24. 24.
    Aronson AE, DeSanto LW. Adductor spastic dysphonia: three years after recurrent laryngeal nerve resection. Laryngoscope 1983;93:1–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Binz T, Blasi J, Yamasaki S, et al. Proteolysis of SNAP-25 by types E and A botulinal neurotoxins. J Biol Chem 1994;269:1617–1620.PubMedGoogle Scholar
  26. 26.
    Scott AB. Botulinum toxin injection of eye muscles to correct strabismus. Trans Am Opthalmol Soc 1981;79:734–770.Google Scholar
  27. 27.
    Ludlow CL, Naunton RF, Sedory SE, et al. Effects of botulinum toxin injections on speech in adductor spasmodic dysphonia. Neurology 1988;38:1220–1225.PubMedGoogle Scholar
  28. 28.
    Miller RH, Woodson GE, Jankovic J. Botulinum toxin injection of the vocal fold for spasmodic dysphonia: a preliminary report. Arch Otolaryngol Head Neck Surg 1987;113:603–605.PubMedGoogle Scholar
  29. 29.
    Jankovic J, Brin MF. Botulinum toxin: historical perspective and potential new indications. Muscle Nerve Suppl 1997;6:S129–S145.PubMedCrossRefGoogle Scholar
  30. 30.
    Blitzer A. Botulinum toxin A and B: A comparative dosing study for spasmodic dysphonia. Otolaryngol Head Neck Surg 2005;133:836–838.PubMedCrossRefGoogle Scholar
  31. 31.
    Sulica L, Blitzer A. Botulinum toxin treatment of spasmodic dysphonia. Op Tech Otolaryngol Head Neck Surg 2004;15:76–80.CrossRefGoogle Scholar
  32. 32.
    Chitkara A, Meyer T, Cultrara A, et al. Dose response of topical anesthetic on laryngeal neuromuscular electrical transmission. Ann Otol Rhinol Laryngol 2005;l 4:819–821.Google Scholar
  33. 33.
    Green DC, Berke GS, Ward PH, et al. Point-touch technique of botulinum toxin injection for the treatment of spasmodic dysphonia. Ann Otol Rhinol Laryngol 1992;101:883–887.PubMedGoogle Scholar
  34. 34.
    Ford CN, Bless DM, Lowery JD. Indirect laryngoscopic approach for injection of botulinum toxin in spasmodic dysphonia. Otolaryngol Head Neck Surg 1990;103:752–758.PubMedGoogle Scholar
  35. 35.
    Rhew K, Fiedler DA, Ludlow CL. Technique for injection of botulinum toxin through the flexible nasolaryngoscope. Otolaryngol Head Neck Surg 1992; 111:787–794.CrossRefGoogle Scholar
  36. 36.
    Damrose JF, Goldman SN, Groessl EJ, Orloff LA. The impact of long-term botulinum toxin injections on symptom severity in patients with spasmodic dysphonia. J Voice 2004;18:415–422.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Jerome S. Schwartz
  • Phillip Song
  • Andrew Blitzer

There are no affiliations available

Personalised recommendations