Dr. Gott: Lozenges unavailable to treat spasmodic dyphonia
DEAR DR. GOTT: I have been diagnosed with spasmodic dysphonia, which is not on your list of health reports. I have to wait another five months for an appointment with an ENT specialist. In the meantime, I must continue talking, as I am a teacher of FSL (French as a Second Language) and my work means I talk all day long. I’ve tried getting slippery elm lozenges, which are supposed to help the voice, but they are presently unavailable in Canada. So what can I do, short of not talking, to reduce or relieve symptoms?
DEAR READER: Spasmodic dysphonia (SD) is a neurological disorder of the larynx, or voice box. When a person speaks, air from the lungs is forced between the vocal cords (referred to as vocal folds). This airflow causes the vocal cords to vibrate, which in turn produces the voice. In the case of spasmodic dysphonia, the muscles within the vocal folds can spasm, interfering with these folds and preventing the occurrence of a normal voice sound.
Instead, these spasms give the voice a strained quality, often making it extremely difficult for others to understand what a person is saying. The condition commonly begins when a person is in his or her 30s to 50s and may progress from mild to serious. It is more common in women than in men and can last a lifetime.
There are several forms of SD. The most common one, accounting for almost 80 percent of all cases, occurs when the vocal cords hit together and stiffen during speech, causing the individual to speak in a breathless, strained manner. The person will likely run out of air when attempting to talk. A less common form involves the forceful closure or spasm of the voice box during speech. Still another possibility, while rarer still, is when a person has both conditions.
Symptoms may begin with the observation of strained voice tones that might be attributed to other causes. Several specialists, including an ear-nose-and-throat physician and perhaps a neurologist, may be consulted for an appropriate diagnosis.
The cause of SD is unknown but may be linked with an abnormality of the central nervous system and basal ganglia – the cluster of nerve cells within the brain that coordinates movement of muscles throughout the body. The voice can appear completely normal or near normal at times but not at other times. SD may be hereditary; however, this is a rare disorder, and that makes genetic studies difficult.
While there is no cure, therapy is available and might involve the services of a speech pathologist or botulinum toxin (Botox) injections to temporarily weaken or paralyze the muscles to eliminate spasms. Unfortunately, the BOTOX route is a temporary one and may require repeat injections up to four times a year. Other possibilities include cutting one of the smaller branches of the nerve leading to the larynx or adjusting the framework of the larynx; these latter procedures are reserved for the patient who fails to respond to BOTOX injections.
Other than BOTOX, I am reluctant to recommend such therapy as acupuncture, tai chi, or over-the-counter remedies. I don’t want to mislead you into thinking alternatives might stabilize your situation, but five months is a long time to wait. Ask a friend from the U.S. to send you some lozenges.