Spasmodic Dysphonia

Spasmodic Dysphonia

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Spasmodic dysphonia is a neurological voice disorder that’s often misunderstood and misdiagnosed. Duke laryngologists -- ear, nose, and throat (ENT) doctors who specialize in voice disorders -- are experts in diagnosing spasmodic dysphonia. We offer customized treatments and therapy to help you find relief. Appointments are available in Durham and Raleigh.

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About Spasmodic Dysphonia

Spasmodic dysphonia is a neurological voice disorder that causes involuntary spasms of the vocal cords. If you have spasmodic dysphonia, your voice may sound hoarse, jerky, quivering, strangled, tight, or even breathy, sometimes to the point where it is difficult to speak. The vocal spasms are due to a faulty connection between a nerve and the muscle that controls your larynx (voice box). Some people may have tremor in addition to spasmodic dysphonia, so accurate diagnosis by skilled voice experts is crucial to make sure you receive appropriate treatment.

There are two types of spasmodic dysphonia. Some people have characteristics of both.

  • Abductor spasmodic dysphonia occurs when the vocal cords spasm open, which results in a breathy voice that can sound like a whisper.
  • Adductor spasmodic dysphonia occurs when the vocal cords spasm shut, which causes a strained and strangled voice.

While there is currently no cure, our laryngologists and speech pathologists can offer a combination of proven treatments and voice therapy to alleviate your symptoms and help you live with the condition.

Our Locations
Duke Health offers locations throughout the Triangle. Find one near you.


Comprehensive Evaluation

Assesses how you use your voice and what your voice sounds like. When spasmodic dysphonia is suspected, your speech pathologist completes a detailed evaluation of your speaking patterns, with a particular focus on the signs of spasmodic dysphonia. Your laryngologist will evaluate the role of any medical conditions that can cause voice changes, such as surgeries or recent illness. We will perform a head and neck examination and a visual examination of your voice box.


This detailed visual exam helps us evaluate how your vocal cords vibrate while you make sounds. A tiny camera attached to a small tube called an endoscope is inserted through your nose and allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow motion video images of your vocal cords. The exam takes about a minute; your nose may be sprayed with topical anesthetic for your comfort.

Your team analyzes the images to look for lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. After the exam, your team will review the images with you to determine an accurate diagnosis and treatment plan together.

Laryngovideostroboscopy is often essential to reach an accurate diagnosis and determine the best treatment for your voice.

Computerized Acoustic Analysis

An acoustic assessment creates a visual display on a computer screen as you speak into a microphone. You and your speech pathologist can see characteristics of your voice, including pitch, loudness, and vocal quality. It identifies abnormalities, including subtle vocal problems that cannot be detected with the unaided ear. It may be repeated during treatment to monitor your progress. This non-invasive exam is usually completed on your second visit.

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Botulinum Toxin (Botox) Injection

Your laryngologist injects botulinum toxin (Botox) through the neck and into the vocal cord. This temporarily weakens overactive vocal cord muscles to allow you to speak more easily and clearly. A neurologist assists with electromyographic (EMG) guidance, which detects electrical activity in the muscle and helps ensure accurate placement of the injection. Repeat injections are usually needed every four to six months.

Voice Therapy

A speech pathologist will guide you through vocal exercises to improve our breathing, reduce throat strain, and minimize your symptoms of spasmodic dysphonia. Although Botox injections are often the treatment of choice for spasmodic dysphonia, the benefits from Botox can often be enhanced with voice therapy. Some people with very mild spasmodic dysphonia can find some relief from their symptoms with voice therapy alone.

Why Choose Duke

A Team of Experts
Your care team will include laryngologists with advanced training and years of experience in diagnosing and treating spasmodic dysphonia. They work closely with speech pathologists who are specially trained to evaluate and treat people with voice problems and have expertise in managing spasmodic dysphonia.

The Latest Technology and Treatments
If you receive Botox injections for your spasmodic dysphonia, we'll use sophisticated technology designed to enhance your treatment's accuracy and effectiveness.

Coordinated Care
Because spasmodic dysphonia is a neurological condition, we may also partner with Duke Health neurologists to ensure you receive the best therapies to minimize your symptoms and improve your voice.

Active Research to Advance Care
Our ongoing research ensures you receive the best, most up-to-date care for your spasmodic dysphonia.

Duke University Hospital is nationally ranked in 10 adult specialties
Consistently Ranked Among the Nation’s Best Hospitals
In addition, Duke University Hospital is proud to be named the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2019–2020.
Reviewed: 08/23/2018