What Causes Spasmodic Dysphonia | Signs, Types & Treatments

If your voice suddenly sounds strained, shaky, or breaks in the middle of a sentence, you might be wondering what’s happening. For some people, this change isn’t just from a cold or overuse—it’s something called spasmodic dysphonia, a rare but treatable neurological voice disorder.

Let’s talk about what causes spasmodic dyphonia and how to treat it. 

What Is Spasmodic Dysphonia?

Spasmodic dysphonia (also known as laryngeal dystonia) is a long-term voice condition caused by abnormal nerve signals that affect the muscles in your voice box (larynx). It is a rare condition that affects 500,000 people in the US.

These signals cause your vocal cords to spasm, which interrupts how your voice sounds when you talk. It’s part of a group of movement disorders called dystonias, which affect how certain muscles in your body move.

When you try to speak, your vocal cords should come together and vibrate smoothly to produce sound. With spasmodic dysphonia, the muscles tighten or open unexpectedly. This can make your speech sound:

• Strained or squeezed

• Shaky or choppy

• Breathy or weak

The Science Behind It: What Causes Spasmodic Dysphonia?

Spasmodic dysphonia starts in the brain, not in the throat. The problem lies in how the nervous system sends signals to the muscles that control your vocal cords. Instead of working in smooth coordination, these signals misfire—causing the muscles to tighten or relax at the wrong moments during speech.

Researchers believe that the basal ganglia, a part of the brain that helps control muscle movement, plays a major role. When it doesn’t function properly, the result can be involuntary muscle spasms, including those in the voice box.

It’s also important to separate fact from myth. Spasmodic dysphonia is not caused by anxiety, poor posture, or infection—and it’s not “all in your head.” It’s a real, medically recognized neurological disorder that needs expert evaluation and treatment.

What are the Types of Spasmodic Dysphonia?

There are three main types of spasmodic dysphonia, depending on which muscles in your voice box are affected. Each type changes the sound of your voice differently:

1. Adductor Spasmodic Dysphonia (ADSD)

It causes sudden, involuntary muscle spasms that make the vocal cords tighten and close abruptly. These spasms interfere with how the vocal cords vibrate and produce sound, often making the voice sound strained or effortful. Stress can make symptoms worse. Interestingly, spasms usually don’t occur when whispering, laughing, singing, speaking in a higher pitch, or breathing in while talking.

2. Abductor Spasmodic Dysphonia (ABSD)

This less common type causes sudden, involuntary spasms that force the vocal cords to open. Because the cords stay apart, they can’t vibrate properly—making it hard to produce sound. The open position also allows air to escape while talking, resulting in a soft, weak, or breathy voice. Spasms usually don’t occur when laughing or singing.

3. Mixed Spasmodic Dysphonia

This rare type combines features of both adductor and abductor spasmodic dysphonia. Your voice might switch between tight and breathy sounds.

What are the Symptoms of Spasmodic Dysphonia?

Spasmodic dysphonia can show up in subtle ways at first. Here are some common symptoms of spasmodic dysphonia to watch for:

• Frequent breaks or interruptions in speech, often happening every few sentences

• A voice that sounds hoarse, tight, or strained—and sometimes breathy or “choked” (typical of adductor dysphonia)

• Speech that sounds unusual or difficult for others to understand

• Trouble speaking that may develop gradually or appear suddenly

• Symptoms often disappear when laughing, whispering, speaking in a higher pitch, singing, or shouting

• In some cases, muscle control issues can also affect other parts of the body, such as causing writer’s cramp

It’s easy to confuse spasmodic dysphonia with other voice disorders like muscle tension dysphonia or chronic hoarseness. However, the difference is that spasmodic dysphonia involves involuntary muscle spasms that affect how your voice cords move—not inflammation or overuse.

How Laryngologists Diagnose Spasmodic Dysphonia?

Diagnosing dysphonia can be challenging because the larynx often appears normal, even when symptoms are present. At Colorado Voice Clinic, Dr. David Opperman (Otalryngologist) combines years of specialized experience and advanced diagnostic tools to accurately identify muscle tension disorders like dysphonia.

Photo credits to: https://consultqd.clevelandclinic.org/

Dr. Opperman begins by reviewing your medical history and carefully listening to how your voice sounds—paying close attention to breaks, strain, and breathiness. To rule out other possible causes such as vocal nodules, polyps, or even early signs of cancer, he may use a procedure called video stroboscopy.

This painless, in-office exam uses a small camera and a flashing light to create a slow-motion view of your vocal cords as they vibrate. The scope can be gently passed through your nose (a flexible nasopharyngoscope) or through your mouth (a rigid telescope) to give a clear, detailed look at how your vocal cords move. A tiny microphone placed on your neck helps record vibration frequency during the test.

With this advanced approach, Dr. Opperman can pinpoint the exact cause of your voice changes and create a personalized treatment plan to help restore your voice and confidence.

What are the Treatment Options for Spasmodic Dyphonia?

While there’s currently no permanent cure for spasmodic dysphonia, there are highly effective treatments that can help you regain a smoother, more natural-sounding voice. Treatment focuses on calming the spasms in your vocal cords and retraining your voice to function more easily.

Here are the most common treatment options your ENT may recommend:

1. Botox Injections

Botox (botulinum toxin) is the gold-standard treatment for spasmodic dysphonia. It works by temporarily relaxing the overactive muscles in your vocal cords that cause spasms. The injection is done in-office and takes only a few minutes.

2. Voice Therapy

Speech-language pathologists who specialize in voice rehabilitation can help you retrain your speaking habits and reduce tension.

Voice therapy is often used alongside medical treatments to help you maintain long-term vocal health and reduce recurrence.

3. Surgical Treatments (in select cases)

For patients who prefer a longer-term solution, surgical options may be discussed. One option, laryngeal framework surgery—specifically type II thyroplasty—can help manage adductor spasmodic dysphonia (AdSD) by reducing the excessive tightness of the vocal cords that leads to spasms. This procedure aims to restore smoother, more natural voice function and longer-term relief.

Conclusion

Spasmodic dysphonia can feel isolating. This neurological voice disorder may change how you sound, but with modern treatments, most people regain a natural, comfortable voice.

The key is early diagnosis and consistent treatment. Whether you’re a singer, teacher, or someone who simply wants to speak with confidence again, you don’t have to struggle in silence.

At Colorado Voice Clinic, Dr. David Opperman and his team are dedicated to helping patients rediscover their voices. Through advanced technology, compassionate care, and years of expertise, they’ve helped countless people restore not just their voice—but their confidence, too.

FAQs

1. Is spasmodic dysphonia curable?

There’s currently no cure, but treatments like Botox injections and voice therapy can effectively manage symptoms and help you speak more easily.

2. Can stress make spasmodic dysphonia worse?

Yes. While stress doesn’t cause the condition, it can make muscle spasms and voice strain more noticeable. Relaxation and breathing techniques can help ease symptoms.

4. What’s the difference between spasmodic dysphonia and a voice tremor?

A voice tremor causes rhythmic shaking in the voice, while spasmodic dysphonia causes sudden, irregular voice breaks or strain. Sometimes, both conditions can occur together.

5. Can I still sing or speak professionally with spasmodic dysphonia?

Yes—with proper treatment and therapy, many singers, teachers, and speakers continue their careers. Working with an ENT and a voice therapist helps you adapt and protect your vocal health.