Treating Spasmodic Dysphonia

A few years ago Marge (not her real name) was having lunch with her daughter and grandson when she noticed that her voice sounded different.  She told her daughter that she felt as though her voice was “catching” in her throat.  At an annual doctor’s appointment a few weeks later she mentioned it to her physician who recommended that she see a specialist.  Eventually Marge was diagnosed with Spasmodic dysphonia (SD) a neurologic voice disorder that causes spasms in the muscles of the larynx, or voice box.

SD affects adults of all ages with patients often complaining of their voices catching in their throat, interrupting the fluency of speech. These spasms can be quite debilitating, but they can be temporarily treated by injecting Botox into the voice box muscles, weakening them enough so the spasms do not continue. To ensure these injections reach the correct location at the correct dosage so as to give relief for the longest possible time, an Electromyography (EMG) machine is connected to the injection needle. This allows otolaryngologists who treat SD with Botox to see muscle activity on a monitor and confirm the needle is in the right place to inject. Patients like Marge may need this treatment on average every three months depending on their preferences and the medication’s effect. 

In 2017, The Women’s Board bequeathed a grant to the Otolaryngology Clinic at Johns Hopkins to purchase the EMG machine they currently use. This equipment supports this more precise and safer option to treat the 100 plus patients annually who require these repetitive injections, giving them the ability to communicate effectively in a stronger and more fluid voice. This machine also has uses in patients with Parkinson’s disease and essential tremor in cases where these illnesses affect the voice.

Interview with Dr. Lee M. Akst