With his recent entry into the 2024 Presidential election, Robert F. Kennedy, Jr.’s voice has been making news. His dἰagnosis of spasmodic dysphonia has been made public. We believe these inquiries will help shed light on this uncommon voice problem as the sole organization devoted to discovering solutions for rare voice dἰseases.
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— Los Angeles Times (@latimes) June 20, 2023
Find below additional information regarding Spasmodic Dysphonia and Robert F Kennedy Jr health…
What is Spasmodic Dysphonia?
A localized laryngeal dystonia and a chronic neurological vocal problem, spasmodic dysphonia. Depending on the type of spasmodic dysphonia (adductor or abductor), it causes involuntary spasms of the muscles that open or close the vocal folds, resulting in a voice that has broken and a strained/strangled quality or a breathy tone.
Although the neurological foundation of spasmodic dysphonia is well understood, the precise reason is still unknown. The precise reasons for the illness are still being researched, and various brain regions may be implicated.
The cerebellum, which aids in controlling balance, the basal ganglia, which helps govern movement, and the cortex, which initiates movement and perceives sensation, are all being studied by researchers. Because genes have been linked to other kinds of dystonia, there may be a genetic component.
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A thorough evaluation will typically be performed by an otolaryngologist (ENT) and a speech-language pathologist, which will include gathering medical history, reviewing current and onset symptoms, visualizing vocal fold movement during a stroboscopy exam (an endoscopy through the nose or mouth with a special camera and light that permits detailed visualization of vocal fold vibration), and rating various voice qualities.
To find out if there is tension in and around the larynx, palpation of the neck may be used. To help with an accurate diagnosis, the person may also be asked to read or repeat several specific sentences.
What are Common Treatment Options for Spasmodic Dysphonia?
Finding out as much as you can about spasmodic dysphonia therapies can enable you to work with your medical team to assess your options, control your symptoms, and improve your quality of life.
Botulinum Toxin Injections
The laryngeal muscles that govern the opening (abduction) and shutting (adduction) of the vocal folds are injected with botulinum toxin. Botox, which is now the most popular brand used to treat spasmodic dysphonia, acts to stop spasms of the muscles that regulate the vocal folds by inhibiting nerve impulses at the place where the muscle receptor normally signals the muscle to contract.
Depending on the kind of SD, a different laryngeal muscle will be injected; commonly, the posterior cricoarytenoid (PCA) for abductor type and the thyroarytenoid (TA) muscle for adductor type Botox injections must be repeated because this transitory thinning effect lasts for a short time.
The benefits of Botox might last anywhere between 3 and 4 months, depending on the individual. Breathlessness, swallowing difficulties, and stiffness or tenderness at the injection site are all potential short-term side effects of Botox injections.
The treating ENT or speech-language pathologist may offer coping mechanisms to patients at the moment of injection. Although these adverse effects normally pass quickly, they could become more noticeable as the dosage of Botox rises. Unilateral injections, in which only one side of the voice mechanism is injected, are an option offered by some ENTs.
As a result, the Botox effect is less potent or lasts shorter, but there are also fewer side effects after the injection. The individual’s preferences, the advice of the healthcare providers, and the individual’s responses to the previous several Botox injections will all be taken into consideration when discussing unilateral versus bilateral injections and the precise dosage of Botox.
Voice Therapy
Even though spasmodic dysphonia is a neurological condition, voice therapy may be able to help people better manage its symptoms, such as breaks, strain, roughness, breathiness, and effortful voicing, by re-coordinating the speech subsystems (phonation, resonance, and articulation).
A speech-language pathologist (specialist voice therapist) can educate a person on behavioral methods to better control the symptoms of SD through voice therapy. Individual objectives for speech therapy should include techniques for speaking in public, speaking on the phone, speaking more easily, etc.
In addition to counseling for coping with the condition’s negative effects on quality of life, it can offer clients education on spasmodic dysphonia, advice on good vocal hygiene practices, and education on the disorder. Some studies have also demonstrated the value of voice therapy as a Botox injection complement.
Surgical Options
The surgical alternatives for treating spasmodic dysphonia are numerous. Surgery is typically performed to treat adductor spasmodic dysphonia.
Cutting the recurrent laryngeal nerve that innervates the thyroarytenoid and lateral cricoarytenoid muscles and reinnervating the muscles using a separate nerve is known as selective laryngeal adductor denervation-reinnervation (SLAD-R). The vocal folds are minimally separated during Type II Thyroplasty surgery to produce less severe spasms.
The voice may become weaker or breathier as a result, but the spasms may be less severe. Ongoing research is being done on long-term outcomes.
Bilateral Vocal Fold Medialization, a method where a silastic implant or an insoluble injectable material is implanted either by a surgical incision or with an injection through the front of the neck, may be explored for abductor spasmodic dysphonia. Potential risks and advantages should be explored with treating ENT if surgery is an option.
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