Spasmodic Dysphonia

Spasmodic Dysphonia is a rare voice disorder that causes involuntary spasms in the larynx. It’s also known as Laryngeal Dystonia.   

Spasmodic Dysphonia can cause symptoms ranging from breaks in speech and voice, gradual or sudden difficulties producing speech, to a hoarse vocal quality. Because the Larynx may appear normal, Spasmodic Dysphonia may be difficult to diagnose. 

According to Johns Hopkins Medicine, it can be caused by a central nervous disorder which might originate in the basal ganglia within the brain. The disorder has a genetic link, and can also appear due to stress, vocal abuse, or after an illness like a cold or flu. 

Proper diagnosis and treatment are important in order to allow clients with Spasmodic Dysphonia to produce consistent and intelligible speech. Although there isn’t a cure for the disorder at this time, treatment that includes voice therapy from a speech-language pathologist can help reduce symptoms.

If you’re an SLP who might have a client with Spasmodic Dysphonia on your caseload, look here for some of the most important information to know. We’ll cover best practice for assessment and intervention, in addition to billing for the disorder. Also, we’ll be diving into details on a recommended team collaboration and special considerations for working with clients who have Spasmodic Dysphonia. 

Treatment for Spasmodic Dysphonia

Spasmodic Dysphonia occurs when the muscles inside of the vocal folds make involuntary sudden movements. This interferes with typical vocal fold vibrations that occur to produce voice.

Clients with Spasmodic Dysphonia may benefit from voice therapy in speech therapy.  Goals of treatment depend on the type of Spasmodic Dysphonia and the accompanying effects on the individual’s vocal quality. 

There are 3 types of Spasmodic Dysphonia: 

• Adductor Spasmodic Dysphonia: Most common form. Involuntary muscle spasms cause the vocal folds to quickly come together. Vocal quality can be strained and words might be cut off. 

• Abductor Spasmodic Dysphonia: Here, spasms cause the vocal folds to stay open. Because they don’t come together effectively to vibrate during speech production, the individual may have a weak or breathy voice.  

• Mixed Spasmodic Dysphonia: Extremely rare. This is a combination of the other 2 types of the disorder. 

In both Adductor and Abductor Spasmodic Dysphonia, spasms don’t usually occur when an individual is whispering, laughing, or crying. 

Treatment for Spasmodic Dysphonia depends on factors like the client’s age, health, and prognosis. Botox injections into the muscles of the vocal folds may be an option for some individuals. Speech therapy might then be recommended for a period of several weeks at a time in between sets of injections. 

In voice therapy, treatment for Adductor Spasmodic Dysphonia includes: 

• Relaxation techniques

• Learning diaphragmatic breathing 

• Easy onset speech production (to reduce voice breaks in the beginning of sentences) 

• Lessening the number of words per sentence spoken

• Encouraging slight pitch elevation 

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Assessment for Spasmodic Dysphonia

Like many components of managing Spasmodic Dysphonia, assessment for the disorder is best completed as a team approach. 

The SLP can assess the client by looking at the following: 

• Patient history

• Pattern of voice breaks

• Assessment of vocal quality (i.e., hoarse, breathy, strained) through acoustic measurements 

• Conversational speech sample or repetition of phrases

A neurologist may test to determine if there is a neurological disorder contributing to the client’s voice disorder. An ENT will  use imaging such as videostroboscopy to visualize the movement of the vocal folds. 

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Intervention

Intervention for Spasmodic Dysphonia varies depending on the individual, the nature of his or her symptoms, and any co-occurring medical diagnoses. 

Best practice for intervention for Spasmodic Dysphonia includes a comprehensive assessment from a team of professionals. Botox (Botulinum toxin) injections into the affected muscles in the voice box can improve symptoms. 

The injections typically need to be repeated every 3 to 5 months. 

Voice therapy is a key component of intervention for Spasmodic Dysphonia.  The speech therapist can provide education to the individual on the nature of their voice disorder, symptoms, and strategies for compensating with the effects on their speech.  

Collaboration: A team approach

A team approach is crucial to achieving best outcomes with clients who have Spasmodic Dysphonia. 

The medical team for management of the disorder should include: 

• Neurologist
• Otolaryngologist (ENT) 
• Speech-Language Pathologist 

The role of the neurologist is to evaluate for signs of dystonia in the brain and any other movement disorders that might exist. 

An Otolaryngologist (also known as an Ear, Nose, and Throat doctor or “ENT”) can use measurements to evaluate the anatomy and movement of the vocal folds during speech and other activities. This can include fiberoptic nasolaryngoscopy or video stroboscopy. 

The SLP can assess and provide compensatory measures for voice symptoms resulting from the client’s Spasmodic Dysphonia.  Speech Therapy might include assessing the need for AAC. Augmentative and Alternative Communication can be used to amplify the client’s voice, or as a means to help him or her communicate if their speech intelligibility is significantly impacted. 

Some clients may benefit from seeing a psychologist or therapist for counseling for assistance working through the diagnosis, treatment, and potential social consequences of having Spasmodic Dysphonia. 

Special considerations

When working with a client who has a diagnosis of Spasmodic Dysphonia, it’s important to keep in mind that how effective speech therapy outcomes are may depend on the client’s overall care and treatment plan. For example, Botox injections can provide approximately 3 months of relief from symptoms, after which the client may need to return for more injections. 

In some cases, surgery may be recommended. The client may also have a neurological condition such as Parkinson’s Disease, which is causing the Spasmodic Dysphonia. This again may affect the nature of the client’s therapy goals and outcomes. 

SLPs should be sensitive to a client’s unique preferences when working with culturally and linguistically diverse individuals with Spasmodic Dysphonia. What is determined to be an appropriate voice quality, loudness, or pitch may vary depending on a client’s cultural background or geographic location. 

Therapists can refer to ASHA’s Practice Portal pages for details and guidance. 

Billing

When documenting therapy procedures for a client with Spasmodic Dysphonia (also known as Laryngeal Dystonia or Laryngeal Dysphonia), SLPs should use the ICD-10 code R49.0. 

To bill a speech therapy treatment session targeting this voice disorder, the CPT code 92507; Treatment of Speech, language, voice, communication, and/or auditory processing disorder. 

Therapists should be careful not to confuse this with the CPT code 92526, which is used for the treatment of swallowing dysfunction and/or oral function for feeding.