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About Spasmodic Dysphonia

New: SD as a Mindbody Disorder

 According to the American Speech and Hearing Association's definition, Spasmodic Dysphonia or SD, has symptoms that come from more than one source, possibly nervous system changes that produce a tremor, focal dystonia, or in rare cases, as a result of acute or chronic life stress. Symptoms depend on the type of SD:
In ADDUCTOR SD, the vocal folds spasm in the closed position, causing a strained, strangled quality or breaks in the voice. In ABDUCTOR SD, the vocal folds spasm in the open position, causing a weak voice with breathy voice arrests. Tremors may or may not be present. Over half of SD cases develop slowly over time, whereas approximately 35% occur suddenly, usually following laryngitis or an upper respiratory infection.
A brief history of SD can be found in my book, Free to Speak: Overcoming Spasmodic Dysphonia, as well as my journey of reclaiming my voice with breathing and voice exercises. While the current model is trial voice therapy for a short period of time and botox injections into the vocal folds to paralyze them to stop the spasms, some people overcome their SD through rehabilitating the voice. By changing the manner in which voice is produced, the symptoms can be masked, or the voice can recover normal voice production in time. 
To hear my voice before and after voice rehabilitation, click on the links below:

Six months after onset
After resolving sd June 2005
Voice Even Better April 2006


Personal Philosophy: My personal philosophy about SD is ever-evolving. I continue to research adamantly, and as I work with more SD sufferers, I understand the problem more intimately. I have come to view SD as a mindbody disorder; not psychological or neurological, but both. I believe we cannot separate the mind and body functions, including the function of the brain. For more information, see SD as a Mindbody Disorder.

What about Botox? The current popular model of treatment consists of injecting botulinum toxin-A into the vocal fold(s). The toxin creates a temporary paralysis in one or both vocal folds so that spasms are halted. Typically, there is a breathy period initially, a period of fairly normal voicing, and then a return of spasticity over a 3-4 month time frame. Repeat injections are then needed indefinitely. Results are variable and unpredictable, even in the same person. Botox helps some people significantly, but it does not help all people, especially those with the Abductor type of SD. Botox is not a cure, but does mask the symptoms. It is possible to develop a resistance to botox so that it ceases to be effective.
SUPPORT: Support groups can be very helpful for emotional support as well as problem-solving and resources. A good on-line support group is run by Micki Nellis: www.spasmodicdysphonia.us
Posts from anyone are welcome. There is another on-line support group run by the National Spasmodic Dysphonia Association, a group that is funded by the makers of botox. They welcome posts only from lay people with sd that report on the use of botox or surgical procedures. Posts about successes of therapy or any definition of SD other than that of a "focal dystonia of neurological origin" are routinely deleted. Professionals are not allowed to post. The careful researcher should be wary of the limited nature of NSDA literature and communications with regard to the definition and treatment of SD. 

What about voice therapy?

The track record for voice therapy is a poor one. I believe this is because speech therapists are not properly trained to administer voice rehabilitation with the intensity and the holistic nature that SD therapy requires. The emotional piece of SD is huge and there are breakdowns not just in voice production, but in breathing, voice image and more. The “feeling” of proper voice production is lost in a case of SD and must be rediscovered. I am committed not only to helping those with SD recover, but helping speech therapists understand what is needed to truly overcome SD.