Voice therapy for spasmodic dysphonia should focus on decreasing the effort needed to speak.
Producing voice requires a very delicate balance between all the muscles involved in speaking and breathing.
People with SD tend to push and strain their voice out. Because of the vocal spasms, the voice doesn’t come out naturally.
The logical reaction when things don’t go the way you want them to go, is that you try harder.
The more you try, the worse your voice becomes. You start to push more with all the muscles in your body, even the ones in your face.
The right way to produce more voice is counter intuitive; you have to try less. You have to speak softer with less effort.
Voice (speech) therapy for spasmodic dysphonia should do just that.
Exercises to speak easier could be:
- Start with speaking as soft as possible and then gradually turn up the volume
- Speak with maximum resonance; feel your voice more
- Work on diaphragmatic breathing
- Speak at a lower pitch
- Place your voice as low in your body as possible (at the position of your belly-button)
- Sit or stand straight
- Speak more breathy (start a sigh just before you start to speak)
- Humm just before you start to speak
- Make the words flow more. Speak like your singing.
- Speak with a lowered larynx to open up your windpipe. You do this by letting your tongue lie flat and relaxed on the floor of your mouth.
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The device used in the video is a “hex bug” which you can get in the toy store.
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The standard treatment is injections with botuline toxin, Botox. It is a simple procedure
when you have an experienced doctor. You lay down flat on a bed with 2 electrodes
glued to you throat. The doctors first treatment is injecting 2,5 units of Botox. One
injection in both sides of the vocal chords. The whole procedure is painless and should
not take up more then a couple of minutes.
How long before it works
The Botox will start to work after about three days and the effect will last up to three
months. After 1 week you can go back to the doctor to evaluate your voice and take
additional shots if the desired effect is too small.
How to find the correct dose
It takes around 1 to 5 treatments over time to establish the correct dose. After the right
dosage is found you can continue with that over time. You will have to continue the
treatments for the rest of your life because the effects wear out after 3 months.
Disadvantages of the use of Botox:
● Recent analysis of quality-of-life questionnaires in patients undergoing regular
injections of botulinum toxin demonstrate that a large proportion of patients have
limited relief for relatively short periods due to early breathiness and loss-of benefit
● the benefits from injections were significantly reduced in patients in their
seventies and attributed this to the reduction in motor units with aging perhaps
affecting the response to botulinum toxin in spasmodic dysphonia patients
● aphonia, breathiness and swallowing difficulties in the first to fourth week after
injection. This can really interfere with your job because you might be unable to
speak for four weeks.
● optimal voice that was achieved never fully matched normal voice quality or
● Only good effects with ADSD
● The costs for treatment range from 0 to $4000,-
● Every 3 months you have to travel to the hospital.
● You might become immune for the Botox so that it has no effect anymore.
Advantages of the use of Botox:
● Relief-when it works for you, you will have much of your normal life back and
during this time you might forget you have spasmodic dysphonia.
● Happiness– You will feel emotionally better because you can express yourself
● Security– You can continue a normal job
● Freedom– You don’t have to think about speaking anymore, it just flows out.
Below you find a video which shows you injection of Botox.
A number of operations that cut one of the nerves of the vocal folds (the recurrent laryngeal nerve) has improved the voice of many for several months to several years but the improvement may be temporary.
An operation called “selective laryngeal adductor denervation-rennervation (SLAD-R)” is effective specifically for adductor spasmodic dysphonia which has shown good outcomes in about 80% of people at 4 years. Post-surgery voices can be imperfect and about 15% of people have significant difficulties.If symptoms do recur this is typically in the first 12 months. Another operation called “recurrent laryngeal nerve avulsion” has positive outcomes of 80% at three years.