Spasmodic dysphonia causes involuntary movement of the larynx that can lead to extensive vocal strain. In rare cases, this results in an unpredictable opening of the vocal folds with loss of voice and breath.

Overview and Symptoms

SD can begin with a gradual or sudden onset of difficulty in speaking, and symptoms can be mild or severe. Symptoms you may begin to notice include:

  • breaks in your voice when saying certain words or sounds
  • shaking in the voice
  • speaking that requires more effort
  • spasms that interrupt the sound of speaking

During your first diagnostic visit, a speech pathologist will use a diagnostic tool called laryngovideostroboscopy to examine your vocal folds in slow motion.

On a second visit, a speech pathologist will collect acoustic measurements of your voice and have you participate in trial voice therapy techniques.


Treatment for spasmodic dysphonia involves periodic injections of Botox to the larynx to maintain stable voicing, followed by voice therapy. Voice therapy extends the benefits of the Botox treatment and teaches strategies for minimizing the unwanted laryngeal movements.

Voice therapy is much like physical therapy for any other part of the body. Sessions usually take place weekly for about 8 visits. You'll learn about the basic anatomy and physiology of the voice mechanism and about how to care for your voice. Pre-surgical counseling is provided when appropriate.

To achieve the best results, we'll provide exercises to be completed at home. We will do our best to help you figure out how to fit these practice exercises into your daily schedule.

Through practice, the body learns to make the small changes required for effective voice activation and for a smoother, easier voice. Regular practice helps to make these changes automatic so that eventually they come naturally. You may find it helpful to record your voice therapy visit using you smart phone or other recording device to aid with home practice.

If you need surgery, voice therapy may occur either before or after surgery takes place. After, you will have a final voice re-assessment and laryngovideostroboscopy.

Voice, Speech and Swallowing Therapy

The Voice, Speech and Swallowing Therapy experts at BIDMC are nationally recognized leaders, specializing in the diagnosis and treatment of voice, airway, speech and swallowing conditions.

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