$Unique_ID{BRK03682} $Pretitle{} $Title{Dysphonia, Chronic Spasmodic} $Subject{Dysphonia Chronic Spasmodic Dysphonia Adductor Spasmodic Dysphonia Adductor Spastic Dysphonia Abductor Spasmodic Dysphonia Abductor Spastic Dysphonia Dysphonia Spastica CSD} $Volume{} $Log{} Copyright (C) 1987, 1988, 1990, 1991 National Organization for Rare Disorders, Inc. 325: Dysphonia, Chronic Spasmodic ** IMPORTANT ** It is possible the main title of the article (Chronic Spasmodic Dysphonia) is not the name you expected. Please check the SYNONYMS listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Dysphonia Adductor Spasmodic Dysphonia Adductor Spastic Dysphonia Abductor Spasmodic Dysphonia Abductor Spastic Dysphonia Dysphonia Spastica CSD General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Chronic Spasmodic Dysphonia (CSD) is characterized by a difficulty in speaking that resembles stuttering. It is caused by excessively vigorous drawing together (adduction) or apart (abduction) of the vocal cords. The voice sounds hoarse, soft and strained. Symptoms Chronic Spasmodic Dysphonia is a rare disorder of speech characterized by uncontrolled pitch breaks (vocal spasms), a great deal of effort in speaking, and uncontrolled intermittent hoarseness. Patients experience tightness of the throat, and the need to push in order to force their voice out. Onset usually occurs between 20 and 60 years of age. A milder subtype of CSD is characterized by difficulty with controlling speech following certain sounds such as "P", "T", and "K". In the most severe form of CSD patients may be unable to produce any normal sound (aphonia). Consequently, they may speak primarily in a whisper. Often, coughing, laughing, and sometimes singing are less affected than speaking. The breathing pattern in CSD is abnormal. Symptoms are gradually progressive over the first 2 years after which they usually stabilize. Symptoms commonly worsen with stress. The disorder usually remains chronic without marked changes over a period of years. Causes The exact cause of Chronic Spasmodic Dysphonia is not known. The adduction or abduction of the vocal cords may possibly be caused by an impairment of part of the brain (the brain stem). In about 60% of patients, onset of symptoms of CSD follows a severe upper respiratory infection with laryngitis. The disorder may also occur subsequent to head injury or prolonged use of certain drugs (phenothiazines). Some patients may have associated movement disorders such as Tardive Dyskinesia, Oral-Facial Dystonia, Torticollis, or Essential Tremor, which developed either prior to or after the onset of Spasmodic Dysphonia. Diagnosis of Chronic Spasmodic Dysphonia usually includes indirect laryngoscopy to rule out vocal cord structural abnormalities such as nodules, polyps or tumors. Affected Population Chronic Spasmodic Dysphonia affects both men and women, usually between the ages of twenty to sixty years. Related Disorders Chronic Stuttering is characterized by a speech pattern of frequent repetitions or prolongations of sounds, syllables, or words, or by frequent unusual hesitations and pauses that disrupt rhythmic flow of speech. The disorder usually appears before age 12 and is often familial. Essential Voice Tremor is part of Benign Essential Tremor syndrome. It is an involuntary movement of the vocal cords produced by rhythmic alternate contractions of opposing laryngeal muscles. Fine to moderate tremors of other muscles, the hands or head may also occur. These related tremors all appear during adolescence or later in successive family generations. There are no physical (pathologic) findings. Voluntary movement and emotion tend to increase the tremor. (For more information, choose "Benign Essential Tremor" as your search term in the Rare Disease Database.) Vocal Cord Polyps is a common condition which may result in hoarseness and a breathy voice quality. The polyps may be caused by voice abuse, chronic laryngeal allergies, or irritation of the vocal cords by industrial fumes or cigarette smoke. Vocal Cord Nodules (Singer's, Teacher's, or Screamer's Nodules) may be caused by chronic voice abuse, or using an unnaturally low voice. The nodules are concentrations of connective tissue on the vocal cords. They result in hoarseness and a breathy voice quality. Vocal Cord Paralysis may result from lesions in several locations in the brain, the 10th cranial nerve (nervus vagus), the laryngeal nerves, or from neck or chest (thoracic) lesions, neurotoxins such as lead, infections such as diphtheria, or viral illness. Vocal cord paralysis usually results in loss of vocal cord abduction or adduction. The disorder may affect speech, respiration, and swallowing. In Unilateral Vocal Cord Paralysis the voice is hoarse and breathy. In bilateral Vocal Cord Paralysis the voice is very soft (of limited intensity) but of good quality. However, difficulty breathing with wheezing may occur on moderate exertion. Squamous Cell Carcinoma of the Larynx is the most common malignant laryngeal tumor. The earliest symptom of this disorder is usually hoarseness. Early treatment with radiation or surgery of the vocal cords (cordectomy) usually results in an 85-95% chance of cure. Therapies: Standard The symptoms of Chronic Spasmodic Dysphonia sometimes improve when one of the recurrent laryngeal nerves is cut. The voice quality may return to normal and relief from the physical effort to talk may be obtained. However, the nerve can grow back 3-9 months after surgery, resulting in return of symptoms. Approximately 40% of patients have had long-term benefits from this surgery. An estimated 40% of patients will benefit from treatment with the antihypertensive drug propranolol. Speech therapy can be of benefit to patients in conjunction with drug and surgical treatments. Therapies: Investigational Researchers at twelve treatment centers including the National Institute of Deafness and Other Communication Disorders (NIDCD) are currently treating adults who suffer from Chronic Spasmodic Dysphonia with an orphan drug, botulinum A toxin (Botox). This orphan drug is injected in a part of the cartilage of the larynx (thyroarytenoid) on one side, at intervals of several weeks. To date, this procedure has been beneficial in all test cases, with varying degrees of hoarseness and swallowing difficulties as side effects, depending upon dosage. Symptoms usually return after 2 to 3 months and reinjections are required every 2 to 3 months to maintain the therapeutic benefit. Botox is manufactured by Oculinum, Inc. and is distributed by Allergan. Adults over 18 years of age who have had dysphonia for more than 2 years may contact researchers listed below if they wish to participate in research projects on Spasmodic Dysphonia. Dr. Christy Ludlow NIH/National Institute of Deafness & Other Communication Disorders (NIDCD) 9000 Rockville Pike Bethesda, MD 20892 Speech Pathology Unit Bldg. 10, Room 5N226 Bethesda, MD 20892 (301) 496-9365 or Andrew Blitzer, M.D. Professor, Clinical Otolaryngology and Vice-Chairman College of Physicians and Surgeons Columbia University New York, NY 10032 The following agency is conducting research on Spasmodic Dysphonia as well as other debilitating communicative disorders. Physicians with patients who may be interested in the study may contact: Dr. Sandra Chapman Callier Center for Communicative Disorders Dallas Center for Vocal Motor Control 1966 Inwood Rd. Dallas, TX 75235 This disease entry is based upon medical information available through June 1990. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Chronic Spasmodic Dysphonia, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 National Spasmodic Dysphonia Association P.O. Box 1574 Birmingham, MI 48009-1574 Our Voice Spasmodic Dysphonia Newsletter 165 - 5th Ave., Suite 1033 New York, NY 10010-7002 (212) 929-4299 (212) 929-4397 VOCAL (Voluntary Organization for Communication and Language) 336 Brixton Road London SW9 England Dr. Christy Ludlow Speech Pathology Unit NIH/National Institute of Deafness & Other Communication Disorders (NIDCD) 9000 Rockville Pike Bldg. 10, Room 5N226 Bethesda, MD 20892 (301) 496-9365 Andrew Blitzer, M.D. Professor, Clinical Otolaryngology and Vice-Chairman College of Professors and Surgeons Columbia University New York, NY 10032 Dystonia Clinical Research Center at Columbia Presbyterian Hospital 710 W. 168th St. New York, NY 10032 Dystonia Medical Research One E. Wacker Dr., Suite 2900 Chicago, IL 60601-2001 (312) 755-0198 References DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS, 3rd ed: American Psychiatric Association, 1980. P. 79.