Spasmodic Dysphonia: A Rare Disorder That Causes a Raspy Voice

If you’ve heard Robert F. Kennedy Jr. speak recently, you may have wondered about his hoarse, labored way of speaking.

“RFK Jr. has a rare focal neurological condition called spasmodic dysphonia,” says Nicole Maronian, MD, an ear, nose and throat (ENT) specialist at University Hospitals. “Characterized by involuntary spasms of the vocal cords, it’s not usually physically painful but may cause uncomfortable sensations of throat tightness and voice changes. It can also lead to embarrassment and anxiety for people who suffer from it.”

What Causes Spasmodic Dysphonia (SD)?

The exact cause of spasmodic dysphonia isn’t known, but it’s considered a central nervous system disorder. “There are several subtypes of spasmodic dysphonia,” says Dr. Maronian. “RFK Jr. has the most common subtype, which is characterized by a strained voice with spasms that interrupt speaking.”

Associated risk factors often include:

• Genetics. Individuals with a family history of neurological diseases like essential tremor may be at greater risk for the disorder.
• Gender. Spasmodic dysphonia is more common in women than men.
• Age. Symptom onset is most often in middle age.

Spasmodic dysphonia symptoms can be made worse by stress, excessive talking, fatigue and other medical conditions. In some cases, laughing or singing can provide temporary relief from symptoms.

How Is SD Diagnosed?

A collaborative approach is required for diagnosing and treating spasmodic dysphonia. The team may include an ENT specialist, a speech pathologist and a neurologist.

“Diagnosing spasmodic dysphonia can be tricky because the symptoms often mimic other voice disorders and there’s no definitive test to confirm the condition,” says Dr. Maronian. “It’s often diagnosed through a process of elimination by ruling out other causes.”

The team typically performs an endoscopy to observe the movement of the vocal cords, preferably during speech when spasms occur. In some cases, additional diagnostic testing may be used to confirm a diagnosis.

Can Spasmodic Dysphonia Be Treated?

There is no cure for spasmodic dysphonia, but it’s highly treatable. Symptoms are not progressive and typically remain stable over time.

“Treatment is personalized to help reduce spasms and can provide patients with long intervals of relatively normal vocal ability,” says Dr. Maronian. “In many instances, patients say they forget they have the condition.”

Treatment typically combines several approaches, including:

• Botulinum toxin (Botox) injections. Considered the gold standard treatment, Botox is injected into the vocal cords to relax overactive muscles. This makes it easier to speak and improves voice quality. Most patients need injections every 3-4 months and will experience significant vocal improvement in the intervals between injections.
• Speech therapy. “Some people with mild spasmodic dysphonia may benefit from speech strategies such as reduced volume or slower speech to minimize spasms,” says Tracey Newman, MA, CCC-SLP, a speech language pathologist at University Hospitals.
• Surgical interventions. Patients who have responded to Botox may benefit from surgical procedures such as selective denervation and renervation of the laryngeal nerves. These procedures involve the intentional severing (denervation) of specific nerves and reconnecting them (renervation) to a different nerve source, allowing for more targeted control of the vocal cords.

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The ear, nose and throat specialists and speech language pathologists at University Hospitals collaborate to provide patients with expert diagnostics and advanced treatments for all types of throat and vocal cord disorders, including spasmodic dysphonia.