Diagnosis of spasmodic dysphonia

It usually takes a long time, sometimes many years, before the right diagnosis is made.
People notice that their voice is off and sounds different. You first think that it is because
you are fatigued. Then you think you have a laryngitis, maybe caught a cold. It doesn’t
go away and you go to see the doctor.

The doctor

The doctor sees no strange things and sends you to a ENT.
The ENT thinks that it is maybe psychological and sends you to a therapist or
psychologist. You start to doubt your sanity and you become depressed.
Hopefully soon in this process you encounter somebody who knows what is going on.
When you end up with some doctor or speech therapist who can recognize spasmodic
dysphonia you are in luck. They will send you to a specialized ENT who can make the
correct diagnosis.

Medical history

They take your medical history, and then they have a look at your vocal chords while
you have to make certain sounds. There are two ways of doing this.

Flexible endoscope

The doctor will stick the flexible piece through your nose and let is glide down to look at
your vocal chords from above. He looks through the eye-piece on the left to evaluate the
closing and opening of the chords.

Rigid endoscope

This is a straight rod which is inserted through the mouth and can provide better image
quality and video recording of the movement of the vocal chords.

Below you see a video where the flexible and the rigid endoscope are demonstrated.

Spasmodic dysphonia diagnosis

Diagnosis of spasmodic dysphonia is often delayed due to lack of recognition of its symptoms by screening physicians. Most patients who are correctly diagnosed are evaluated by a team that usually includes an otolaryngologist, a speech-language pathologist and a neurologist.

The otolaryngologist examines the vocal folds to look for other possible causes for the voice disorder. Fiberoptic laryngoscopy, a method whereby a small lighted flexible tube is passed through the nose and into the throat, is a helpful tool that allows the otolaryngologist to evaluate vocal cord movement during speech.

Additional diagnostic testing may include stroboscopy, which allows the physician to view the vibrations of the vocal cords in slow motion. The speech-language pathologist evaluates the patient’s voice and voice quality.

The neurologist evaluates the patient for signs of other movement disorders.