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$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.