Spasmodic dysphonia is a neuromuscular disease of unknown cause, sometimes triggered by psychological stress, in other cases due to brain problems in the basal ganglia areas, all of which are theories,
It predominates in women and appears around the age of 50. It is a focal spasm, sometimes associated with other spasms. These laryngeal spasms do not affect breathing or swallowing.
In phoniatric practice we can diagnose this voice pathology from the clinical point of view, visualising the vocal cords through nasopharyngolaryngoscopy and from the acoustic analysis of the voice.
Classification from a phoniatric point of view
This allows us to classify the two types of spasmodic dysphonia from a phoniatric point of view, an abductor; the affected muscle is the posterior cricoarytenoid, the cords separate too much and the air escapes without being able to be phonated. The voice is weak, whispery and suffers from intermittent aphonia. In the middle of a sentence the tone breaks and the air escapes directly without producing any phonation of the voice.
The other is adductor; the muscles affected are the lateral cricoarytenoid, cricothyroid, transverse and oblique arytenoid, and is the most common. The cords are very close together and tense, and there is little airflow for phonation. The voice is hoarse, with an abrupt onset, breathy and sometimes unintelligible. The effort to phonate is very high, so that facial grimacing during phonation is frequent, although it may also be due to other dystonia associated with dysphonia.
Both types of dysphonia make communication difficult, so that the affected person's life changes in all areas: Personal: They suffer periods of anxiety, depression and non-acceptance, it is painful not to be able to express themselves, to have to repeat things, they reject the voice that they do not feel is their own. Family: There are attitudes of incomprehension or paternalism, feelings and dialogues are repressed, the problem tends to be hidden or is taken as a burden, too important and frequent economic expenses arise. Social: The effort and difficulty in phonation, together with people's reactions to dysphonia, make us isolated and misunderstood. We avoid meeting new people and have less of a social life. Work: Causes absenteeism or absence for several days every 3 months for treatment. If the voice is important in their profession, the affected person will be unable to exercise it.
Spasmodic dysphonia is a chronic and incurable disease today. Of all dysphonia, laryngeal dysphonia is the most unknown, even to some specialists, who interpret it as psychogenic. Treatments: currently available, surgical treatment is not very effective because of the short duration of the Botox action and consists of infiltration of the affected muscles with low doses of botulinum toxin (Botox), which is prepared with the bacterium that causes botulism, intoxication that causes muscular paralysis or even death by cardiorespiratory arrest.
Emotional effects The toxin relieves symptoms and reduces pain. This is a significant improvement in quality of life, but the result is temporary. The patient's whole life must be adapted to a cycle that repeats itself every 3-4 months: infiltration -> side effects -> fluid phonation -> loss of the toxin's effect. This disease also entails considerable personal expenses in terms of diet, time and travel to a specialised hospital. It also makes us dependent on an accompanying person, who is not always easy to find. Stressful situations affect them by further altering the phonation of the voice.
The other treatment is the phoniatric rehabilitation, currently here in the clinic otolaryngophoniatrician of the voice we have achieved that the patient with spasmodic dysphonia, manage to control their laryngeal spasms; we use the application of TRAPEUTIC ULTRASOUNDa technique invented by Dr. JAIME BRACHOIn addition, voice and breathing exercises are performed together, but the novelty of this rehabilitation is that the patient creates his or her own stereotype (an expectation that people may have about each person in a particular group). The type of expectation can vary; it can be, for example, an expectation about the personality), before he starts phoning, this helps him a lot from a psychological point of view.
Thank goodness we have had satisfactory results in controlling the laryngeal spasms.