What is dystonia Types of dystonia Voice and laryngeal Click here to download our leaflet on Voice dystonia. Voice dystonia is also known as laryngeal dystonia and spasmodic dysphonia. In this condition, the vocal cords are affected by involuntary spasms. These involuntary spasms of the vocal cords cause the voice to change in quality. When the vocal cords are pulled together (adductor laryngeal dystonia), the voice tends to have a ‘strangled’ quality. If the vocal cords are pulled apart (abductor laryngeal dystonia) the voice can be ‘breathy’ and very quiet. Like most types of dystonia, voice dystonia can be made worse when people are anxious or tired. In most people the condition has no known cause and usually starts in mid-life, but does not affect the mind or the senses. Sometimes the vocal cords are the only part of the body affected, but in some cases other muscles nearby can be affected such as the neck, mouth and the muscles around the eyes. Click here for "What's wrong with my voice?" an article written by Lucy Hicklin FRCS ORL H&N, Consultant ENT surgeon with a special interest in voice problems. How can voice dystonia be treated? To date, no cure exists for laryngeal dystonia, although a great deal of research is being undertaken around the world, with significant progress. Regular injections, which weaken the muscles affected by spasm, are the most effective treatment. Injections need to be repeated regularly and the right gap varies widely between patients - some need injections every couple of months while others can experience benefit from the injections for many months. Treatment of voice dystonia can be difficult, and injections are usually only usually performed by ear, nose and throat (ENT) doctors with special training. The injections provide significant relief for the majority of people but it is not perfect - usually easing symptoms rather than completely eliminating them and the outcome of injections varies between patients. A number of surgical procedures have been tried for voice dystonia. Some people get very good results – but overall the results are mixed and the dystonia may return after a period of time so most ENT doctors recommend sticking with the injections. Some people with voice dystonia can gain benefit from speech therapy. In addition, a speech and language therapist can give guidance on keeping the throat healthy and managing stress both of which can improve the performance of the voice. In other people tablet treatment can be tried, although the results can be quite variable from person to person and side effects can occur. If you would like to join the Dystonia Society Facebook group for voice dystonia click here. Sensory tricks / coping tips for voice dystonia * What can help: Vocal exercise (humming, speaking slowly, reciting nursery rhymes). Volume control (talking softly or loudly). Feeling relaxed. Breathing deeper breaths, exhaling before speaking, not holding onto the breath. Environmental control (talking one-on-one, not being interrupted). Using voice early in the morning. Sensory gestures (covering eyes, pinching nose). Physical exercise (need to check exercise is appropriate with doctor before trying). Mental aspects ("not thinking about it", keeping a good attitude). Miscellaneous (physical rest, vocal rest, warm liquids, laughing). What often makes voice quality worse? * Stress (being tense, being in a hurry). Speaking on the telephone. Speaking in a loud or large space. Trying to talk over noise. Lack of sleep. Negative thinking. Miscellaneous (overuse, weather changes, having a cold). Managing dystonia Coping with dystonia can be done most successfully if the person affected by dystonia (and, where appropriate, their carers) actively manages the condition. Everyone is different and so what this means in practice will vary from person to person. To manage dystonia effectively, people affected by dystonia need information about all aspects of the condition. This can enable them to take control and become the actor of their condition. Click here to read more about managing dystonia. Dystonia and mental health Mental health is a sensitive topic for many people with dystonia as many cases of dystonia are initially mistaken for a mental health (or psychological) condition. In the vast majority of cases, dystonia is a neurological illness and does not have a mental health cause. However, it is also increasingly understood, that although mental health conditions do not normally cause dystonia, there can be an important relationship in some cases between dystonia and mental health conditions such as stress, depression and anxiety. This relationship can be two way - the symptoms of dystonia can cause anxiety or depression but also anxiety and stress can make the physical symptoms of dystonia worse. If you are affected by a mental health problem, it is important to get treatment. Click here to read more about dystonia and mental health. If you would like more information, you can call our helpline on 020 7793 3650. To read case studies of individuals with voice dystonia that have been featured in Dystoniamatters! click on the links below: Mary Buck Carol Garforth Lianne Morgan Phyllis Yates * The information marked with an asterisk is from the US patient advocacy group, the National Spasmodic Dysphonia Association. Disclaimer The Dystonia Society provides the information on this page as general information only. It is not intended to provide instruction and you should not rely on this information to determine diagnosis, prognosis or a course of treatment. It should not be used in place of a professional consultation with a doctor. The Dystonia Society is not responsible for the consequences of your decisions resulting from the use of this information, including, but not limited to, your choosing to seek or not to seek professional medical care, or from choosing or not choosing specific treatment based on the information. You should not disregard the advice of your physician or other qualified health care provider because of any information you receive from us. If you have any health care questions, please consult the relevant medical practitioner.