Behavioral and Environmental Factors Play Role in Spasmodic Dysphonia

Are specific triggers associated with the onset of spasmodic dysphonia?

Background: Spasmodic dysphonia (SD) is an idiopathic voice disorder characterized by a strained, strangled voice quality or a breathy voice with aphonic segments of connected speech. Knowledge regarding causes and predisposing factors remains extremely limited.

Study design: Retrospective chart review.

Setting: New York Head and Neck Institute, Center for Voice and Swallowing Disorders; Weill Cornell Medical College Department of Otorhinolaryngology, New York.

Synopsis: Of 350 charts of SD patients, 169 included patients who recalled their circumstances surrounding onset. Forty-five percent of these patients described the onset as sudden, with perceptions of inciting events identified as stress 42% of the time, upper respiratory infection 33% of the time, and pregnancy and parturition 10% of the time. The authors said the study “highlights the possibility that certain environmental factors may represent a key component in the pathophysiology of this disorder,” and may include peripheral post-viral neuropathy, psychological stressors, endotracheal intubation or end-organ injury. Pregnancy and parturition are factors not previously described. The very nature of the study, a retrospective chart review, is limited in that it is subject to recall bias.

Bottom line: A subgroup of SD patients who perceive their condition to be sudden onset were able to associate it with specific triggers, including environmental and behavioral factors.

Reference: Childs L, Rickert S, Murry T, et al. Patient perceptions of factors leading to spasmodic dysphonia: a combined clinical experience of 350 patients. Laryngoscope. 2011;121(10):2195-2198.

—Reviewed by Sue Pondrom