Functional vocal disorders that occur due to vibration disorders in vocal cords and stand out as voice hoarseness or higher or lower tone of voice are called as Dysphonia. It is used as a broad term for all voice disorders. The foremost cause of dysphonia is the misuse and straining of vocal cords. If misuse of vocal cords continues, tissue deformations such as nodules, polyps, cysts, cancer, or paralysis might occur in vocal cords.
Abrupt functional vocal disorder that occurs as a result of sudden contractions (spasm) is called as Spasmodic Dysphonia. The most important aspect of the disorder is that it is a chronic voice disorder. Said spasms persist for a long time and repeat often.
In spasmodic dysphonia, vocal cords do not show normal movements they are supposed to do. Vocal cords suddenly stiffen and contract. With this abnormal behavior of vocal cords that produce voice, the voice suddenly gets hoarse or becomes muffled, wobbling, and interrupted. During spasms, involuntary functions of vocal cords and larynx are normal, only the voice is affected. Spasms might repeat a couple of times in a day.
Although Spasmodic Dysphonia shows similarities to psychiatric disorders, it is a completely organic disorder. It usually occurs in people between the ages of 30 and 50 and starts with sporadic difficulties in producing voice and evolves into a more frequent and challenging problem over time.
The exact cause of Spasmodic Dysphonia is not known. Therefore, it is hard to diagnose. The disorder can be diagnosed with a concurrent examination by an ear-nose-throat specialist, a neurologist, and a language and speech therapist to examine the vocal cords and their functions, brain and neural functions, as well as the functions of voice production and use.
Although methods such as drug treatment, voice therapy, thyroplasty, electrical muscle stimulation are occasionally administered in Spasmodic Dysphonia, there is not a treatment that is generally accepted and ensures a complete recovery. Nowadays, the tension of vocal cords can be reduced by applying Botox (Botulinum Toxin) injection to one or both vocal cords and spasm complaints stemming from weakening vocal cords can be minimized. This treatment method has become the most preferred method compared to other methods.
Botox (Botulinum Toxin) is produced from Clostridium Botulinum bacterium that is available in nature. In fact, it is a virulent toxin. However, it can be administered to humans in minimal concentrations.
Contractions of muscles occur with adherence of a chemical called acetylcholine, released by nerves, to the receptors on muscle cells. Botox prevents the release of acetylcholine by the nerves, thus weakens the muscles and prevents spasms.
In patients with Spasmodic Dysphonia, botox is generally injected into vocal cords by entering from the neck area with a small syringe. Depending on the condition and request of the patient, it can also be injected into vocal cords from the inner side of the throat by entering from the mouth with a long syringe. This loosens vocal cords and spasms get weaker.
In light of the diagnosis made, it can be applied to one or both vocal cords. There is no risk of poisoning, and it does not disseminate into the body. The amount of botox used in aesthetic surgeries is generally 40-80 doses. The dose used for Spasmodic Dysphonia is mostly 1-2 doses, with a maximum of 15 doses. Botox shows its effects within 24 to 72 hours. Rarely, this period might go up to 5 days. After botox shows its effects, patients generally go through three phases:
Breath Phase: It is the phase when the effect of botox is at its strongest and voice cord muscles are at their weakest. Voice is weak and high-pitched. Temporary difficulties in swallowing and gulping might be experienced. It might last for a couple of days or weeks.
Normal Phase: The effect of botox is at normal level and muscles of vocal cords get a bit stronger, but they still are relaxed enough to not cause spasms. Voice and breathing are normal. It might last for a couple of weeks or months.
Renewal Phase: The effect of botox diminishes and disappears, muscles of vocal cords get stronger again, and spasms might recur. Voice and breathing get worse. The need for a new injection emerges.
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