When you can't talk, but you can sing

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We all know the things that deal a blow to our voices. Anything that injures the throat physically, like a hit or a physical constriction, will leave us croaking. Same with infections, or excessive use of the voice, or sometimes just plain stress. We've all experienced the strange semi-choking sensation of not being able to make a sound. For some few, roughly four out of every hundred thousand, that first spasmodic chocking of the vocal cords never goes away. These people are generally aged thirty to fifty, and have no family history of voice disorders, but their vocal cords physically never recover, continually going into spasm, sometimes after every sentence, and sometimes after every other word. This is spasmodic dysphonia.

Dysphonia is a deliberate variation on the word dystonia, which doctors use to describe loss of muscle control. The muscles that people with spasmodic dysphonia lose control over are the ones in the throat that control the vocal cords. They continually spasm, either pushing the cords — actually folds of flesh — together so they cannot vibrate, or stretching them apart so they're too open to make a sound. Although the condition is precipitated by a physical event, like injury or infection, it is believed to originate is a defect in the basal ganglia, the part of the brain that regulates muscle coordination.


Doctors know that the problem isn't localized in the cords themselves, because while a person with spasmodic dysphonia will have an incredibly tough time talking, they can use their voice for other things. The constant seizing in the vocal cords lets up when they laugh. More tellingly, they can sing in long, uninterrupted bursts. Some people can even make speeches to large audiences, while being unable to have intimate conversations. Only the part of the brain that deals with one particular mode of speech is affected.

This makes it sound like a mental disorder, rather than strictly physical one, but researchers are also able to rule out a psychosomatic cause for spasmodic dysphonia. While there are some cases of it being psychosomatic, they often quickly improve with therapy. Even those cases that persist are different from neurological dysphonia. People who have the psychosomatic disorder are not consistent in the timing, quality, and duration of their interruptions. Although they feel unable to control the disorder, it's a psychological loss of control, not a physical one. Fortunately, these people are often able to overcome the disorder with help. One patient stopped after a single therapy session.


Those with the neurological disorder don't have a permanent solution. Their disorder is treated with regular injections of botox to the problem areas. The paralysis stops the spasms, but patients have to learn to talk without engaging those particular muscles. Although many are frustrated because they sound breathy or "off," they quickly learn how to work around the paralyzed parts of their throat and regain their voice. So far, most people need life-long treatment with botox to get by, but recently one man with spasmodic dysphonia has learned to use inspiratory speech. He's talking on the indrawn breath, rather than the outgoing one, in order to relieve his symptoms. That might not be a solution for all patients, but it could be for the people who aren't in favor of constant botox.

Top Image: Daria

Second Image: Alan Hoofring

Via NCBI, Cleveland Clinic, EuroPubMed, Journal of Voice, and Wiley Online Library.