Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India.
What is spasmodic dysphonia?
Spasmodic dysphonia is a condition that causes your vocal cords to open and close involuntarily and it is a neurological disorder affecting the voice muscles in the larynx. This affects your speech and tone of voice because air cannot flow properly through the vocal cords. It can affect your ability to pronounce consonants like p, t, l, s, f, h and th.
In spasmodic dysphonia, the muscles inside the vocal folds experience sudden involuntary movements called spasms which interfere with the ability of the cords to vibrate and produce voice.
Spasmodic dysphonia causes voice breaks and can give the voice a tight, strained quality. People with spasmodic dysphonia may have occasional breaks in their voice that occur once every few sentences. Usually, however, the disorder is more severe and spasms may occur on every other word, making a person\’s speech very difficult for others to understand.
Types of spasmodic dysphonia
and Adductor spasmodic dysphonia is the most common form of spasmodic dysphonia. It is characterized by spasms that cause the vocal cords to slam together and stiffen. These spasms make it difficult for the vocal folds to vibrate and produce sounds. Words are often cut off or are difficult to start because of muscle spasms. Therefore, speech may be choppy. The voice of someone with adductor spasmodic dysphonia is commonly described as strained or strangled and full of effort. Stress often makes the muscle spasms more severe.
and Abductor spasmodic dysphonia is characterized by spasms that cause the vocal folds to open. The vocal folds cannot vibrate when they are open too far. The open position also allows air to escape from the lungs during speech. As a result, the voice often sounds weak and breathy. As with adductor spasmodic dysphonia, the spasms are often absent during activities such as laughing, crying, or shouting.
Causes of spasmodic dysphonia
The exact cause of spasmodic dysphonia is unknown. Because the voice can sound normal or near normal at times, spasmodic dysphonia was once thought to be psychogenic, or originating in a person\’s mind, rather than from a physical cause. In rare cases, psychogenic forms of spasmodic dysphonia do exist; however, in most instances, the muscle spasms are caused by abnormalities in the central nervous system.
A disorder that involves involuntary muscle contractions is also called a dystonia; therefore, another name for spasmodic dysphonia is laryngeal dystonia. Spasmodic dysphonia is considered a form of focal dystonia, a neurological disorder that affects muscle tone in one part of the body. Writer\’s cramp is another type of focal dystonia. Other dystonias can affect multiple regions of the body or the entire body.
Spasmodic dysphonia may co-occur with other dystonias that cause involuntary and repetitious movement of such muscles as the eyes; face, body, arms, and legs; jaws, lips, and tongue; or neck.
Spasmodic dysphonia is thought to be caused by abnormal functioning in an area of the brain called the basal ganglia. The basal ganglia consist of several clusters of nerve cells deep inside the brain. They help coordinate movements of the muscles throughout the body. Recent research has found abnormalities in other regions of the brain, including the brainstem.
How to make the Diagnosis
The ENT surgeon examines the vocal cords by fiberoptic nasolaryngoscopy to evaluate the structure and movement of vocal cords during speech and other activities. The speech-language pathologist evaluates the types of voice symptoms to see if they are characteristic of spasmodic dysphonia or other voice disorders and voice quality. The neurologist evaluates the patient for signs of other muscle movement disorders.
Conventional treatment of SD
The most common treatment for spasmodic dysphonia is the injection of very small amounts of botulinum toxin directly into the affected muscles of the larynx. Botulinum toxin is produced by Clostridium botulinum, the same bacterium that occurs in improperly canned foods and honey. The toxin weakens muscles by blocking the nerve impulse to the muscle. Botulinum toxin injections generally improve the voice for a period of three to four months, after which the voice symptoms gradually return.
Repeat injections are necessary to maintain a good speaking voice. Initial side effects, including a temporary weak, breathy voice and occasional swallowing difficulties, usually subside after a few days to a few weeks. Botulinum toxin will relieve symptoms of most cases of adductor spasmodic dysphonia and is helpful in many cases of abductor spasmodic dysphonia.
Speech therapy is another form of treatment that may work to reduce symptoms in mild cases. Other people may benefit from psychological counseling to help them accept and live with their voice problem.
Yoga Therapy for Dystonia
The feeling of helplessness can be considerable and most patients get into depression after several treatment modalities have failed.
Those doing yoga exercise benefits movement-disorder like Parkinsons, multiple sclerosis patients, strokes, fibromyalgia and arthritis. The relaxation associated with yoga can be positive for anyone with a movement disorder.
Throat chakra: Vishudhaa chakra
The fifth chakra or the throat chakra of the Kundalini system is said to be located in the throat and neck region of a person. The fifth chakra is said to be related to the attributes of communication and other voice disorders. The fifth chakra is located in laryngeal plexus of autonomic nervous system. The fifth chakra is related to the highest truth related to self and creativity. Therefore many singers, public speakers and musicians have fifth chakra as their predominant power. Once you understand and learn to balance your fifth chakra, you will be able to enter your personal power and core truth. This core truth will help liberate your true self.
The throat chakra governs the neck area which involves the thyroid and parathyroid glands, larynx and pharynx. When one is suffering from fifth chakra imbalance, one fears expression of self. This leads to self blockages or over transitiveness or self-righteous.
People suffering from fifth chakra issues are prone to health disorders like a chronic sore throat, ulcers of the mouth, throat cancer, laryngitis, joint problems, thyroid problems, etc.
Ways to balance the Throat chakra
Using the sound of your voice to sing, hum or recite a mantra can be very liberating. The sound of “om” is known as the universal sound that is sacred. The vibrational tone of the word can fill your mind and body with its resonance. Many people are surprised by the amount of tension there is in their throat and voice.
Sarvangasana and Halasana are beneficial to balancing this chakra. Ustrasana, an intense backward bend can open and release the tightness build up in your neck and throat.
Neck massage is great for the throat chakra, by relaxing your neck muscles, particularly around your jaw and thyroid area where there is a lot of tension stored.
What are the seven chakras of Kundalini yoga?
and Sahasrara: The sahasrara is also known as the crown chakra. It is located above the head outside the body. This chakra is connected with the chakra of consciousness and helps connect the soul with the higher spiritual truth. The seventh chakra that is associated to the pineal gland and upper brain.
and Ajna: The ajna or the third eye is the sixth chakra. It is located between the eyebrows and therefore known as the third eye. It is related to the psychic sense and spiritual healing and enlightenment. This chakra is associated with the pituitary gland, lower brain, ears, nose and nervous system.
and Visuddha: The visuddha or the throat chakra is the fifth chakra.
and Anahata: The anahata or the heart chakra is located between the shoulder blades in the middle of the chest. This chakra helps one love oneself and others. It relates to an open heart that can receive as well as give love. The anahata chakra is associated with the thymus, heart, blood and circulatory system.
and Manipurna: The manipurna or the solar plexus is located just above the navel and is the third chakra. This chakra is related to the sense of personal power and self-esteem. The third chakra is associated with the pancreas, stomach, liver, gallbladder and digestive system.
and Svadhisthana: The svadhistana or the sacral chakra is the 2nd chakra. It is located near the genital area and rules sexuality and reproduction. It relates to the way one reacts to power symbols of money, sex and control. This chakra if not controlled properly can lead to addictive behavior. It is associated with the general health, digestive system and functions of liver, pancreas and spleen.
and Muladhara: The muladhara or the root chakra is the first chakra and located at the base of the spine. It is said to be the seat of Kundalini and helps ground one to the emotional and spiritual energies. It related to self-preservation, animal instincts, taste and smell.
Yoga can help Parkinson’s
Parkinson’s disease is one of the most well-known movement disorders. Parkinson’s is a neurological condition that affects movement. The symptoms include tremors, shaky hands, impaired balance, coordination impairments and poor posture. According to the Parkinson’s disease and Movement Disorder Society, yoga can help control symptoms of the disease. Yoga helps reduce the stiffness and rigidness associated with Parkinson’s due to the stretching involved. In addition, doing yoga can also increase mobility, flexibility and strength in patients with Parkinson’s disease.
Yoga can help Multiple Sclerosis
Multiple sclerosis, more commonly known as MS, is a neurological disorder that causes messages from the brain to your body to slow down or stop. This is because your immune system attacks the myelin that protects nerve cells. MS causes muscle weakness, poor coordination and balance, and memory problems. Yoga has the potential to relax you, which can assist alertness and memory skills. Yoga releases the muscle tension and thus reduces the spasticity.