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LARYNGEAL DYSTONIA
Laryngeal Dystonia
is rare. It has been estimated that an ENT surgeon will see one patient every
five years. So a GP may not see a case during his or her working life. Laryngeal
Dystonia is usually confined to the intrinsic laryngeal muscles whose job it is
alter the size of the glottic opening by varying the position of the vocal
cords.
Likely
Presentation
Patients are mainly
female, in their 30’s and 40’s. They report mild hoarseness progressing over
one or two years to characteristic vocal symptoms; 20 percent of patients have
multi-focal features, usually with Dystonias affecting the cranio-cervical region,
5 percent have generalised Dystonia and 10 percent have an associated head
tremor.
Adductor
laryngeal Dystonia accounts for 90 percent of vocal Dystonia. It involves the
adductor laryngeal muscles and leads to a staccato, ‘strangled’ voice, due
to increased tone and hyper-adduction of the true, and sometimes the false, vocal
cords. Speech is interrupted by voice breaks, rhythm disturbances and pitch
variations. Some patients try to overcome these difficulties by whispering or
raising the pitch.
Abductor
laryngeal Dystonia accounts for 10 percent of cases. This results in a week,
husky voice which is suddenly interrupted by periods of breath, whispering aphonia. Sudden spasms of the posterior cricoarytenoid results in incomplete
apposition of the vocal cords.
When to refer
Any patient who has
had a bad weak or husky voice for more than a month should be referred to an ENT
surgeon; a patient with possible Laryngeal dystonia is no exception. Such
patients may then be referred on to centres that specialise in voice
disturbances. Many patients with Laryngeal dystonia are referred incorrectly for
psychiatric assessment at some point because of the curious nature of the voice
changes.
Those who get to a
specialist centre are likely to be those whose job depends on their voice and
who are, therefore, most persistent in getting help. Botulinum Toxin is now the
treatment of choice for Laryngeal dystonia. Treatment is carried out under local
anaesthetic in an outpatient clinic under EMG guidance. Patients should be
warned that they may get mild dysphagia, a weak cough, or slight pain at the
injection site.
Exercises to
reduce voice tension
1 Relaxation of the
throat muscles – Yawn, Sigh.
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Yawn – When you
gently yawn or stimulate a yawn, the muscle of the vocal folds are stretched and
opened slightly.
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Sigh – As you
easily vocalise or sigh an "ee" or "ah" on a yawn, the
larynx relaxes. Sigh with an easy "ee" sound, slightly elevating the
pitch.
2 Relaxation of the
neck muscles.
-
Head Rolls.
Gently roll the head in circle to the right. Repeat to the left. Move the head
slowly. Utilise half circles if it is more comfortable. (Do not perform this
exercise if it increases tension.).
-
Elevate the chin,
letting the back of the neck move backward until it comes to a comfortable
resting place. Slowly lower the chin bringing the head forward to a balanced,
relaxed placement that frees the tension in the back of the. (You may have to
repeat this exercise more frequently at first to get the feel of the
relaxation).
3. Relaxation of tongue
muscles.
4. Relaxation of the neck
muscles.
-
Release the jaw
gently, moving it from side to side as if you were eating jello or oatmeal
(sometimes an easy "mm" sound is more relaxing).
-
Frequently
throughout the day remind yourself to easily relax the jaw, making sure that the
teeth are not clenched tightly together. (You may need to do this frequently
throughout the day the first couple of weeks to effectively combat a pattern of
jaw of teeth clenching).
Susan Shulman, MS,
COC, SPA
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