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Tonic Variant Spasmodic Dysphonia

A variant of spasmodic dysphonia (SD) in which the spasms (and their effect on the voice) are sustained rather than intermittent. Tonic variant spasmodic dysphonia is to be distinguished from classic variant SD.

Individuals with a tonic variant of adductor SD have a sustained strained-sounding voice. Individuals with a tonic variant of abductor SD have a voice that is more or less continuously breathy. Tonic variant SD goes undiagnosed or misdiagnosed far more frequently than does classic variant SD.

“Pure” Tonic-Variant AD-SD

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tonic-variant adductory spasmodic dysphonia

Strained and pressed sounding voice (1 of 4)

At speech pitch of B3 (247 Hz), the not only true, but also false cords are continually compressed together and voice is very strained and pressed-sounding.
False cords relax

False cords relax (2 of 4)

Just a note higher, at C4 (262 Hz), false cords relax a little to reveal the true cords.
true cords are now nearly completely seen

Voice quality less strained (3 of 4)

An octave above, in falsetto, true cords are now nearly completely seen. Voice quality is less strained. This exemplifies the common but not universal finding that falsetto is less affected by the dystonia than chest register.
marked adductory tone during breathing

Adductory tone during breathing (4 of 4)

This patient’s larynx also demonstrates marked adductory tone during breathing, though not to the point of classifying this individual as having a respiratory dystonia component.

State Whisper

In this series, we compare a patient’s normal glottal configuration—true cords clearly visible and false cords lateralized—with his laryngeal appearance during speech, when his “stage whisper” tonic variant adductory SD is produced by an over-closed larynx.

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Normal Glottal Configuration

Normal Glottal Configuration (1 of 2)

This typical vocal cord configuration for phonation represents what is seen in normal speakers. In this man with “stage-whisper” adductory spasmodic dysphonia, such normal vocal fold approximation occurs only during falsetto phonation. As is often—but not always—the case in adductory SD, the characteristic spasmodic manifestations may be much less evident or even disappear when the patient produces voice in the falsetto register. That explains why the laryngeal configuration here appears entirely normal: he is phonating in his falsetto.
Squeezed Vocal Cords of Tonic Variant Adductory SD

Squeezed Vocal Cords of Tonic Variant Adductory SD (2 of 2)

The same man, speaking in chest register, involuntarily produces his strained, stage whisper quality and the dystonic spasms bring false vocal cords and true cords into an over-adducted posture.

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Tonic AD-SD compared to MTD

4 Types of Tonic Variant AD-SD | Tonic SD Is NOT Muscle Tension Dysphonia (MTD)

Do spasmodic dysphonia (SD) and muscular tension dysphonia (MTD) deserve to be included in the same discussion? Yes, but only because they can be confused with one another when in fact they are very different disorders.

Dr. Bastian discusses in this video how a tonic variant of SD may not be understood by some clinicians because they manifest continuous strain without phonatory arrests (breaks).

He offers examples of 4 types of tonic variant adductory SD and how these variants differ from MTD. This distinction is crucial to make so that patients do not get the wrong treatment for their voice disorder.

Audio Examples

Patient Examples

What AD-SD sounds like YT Thumbnail

AD-SD | Tonic Variant

Adductory spasmodic dysphonia is a variant of spasmodic dysphonia in which the spasms push the vocal cords together, choking off or straining the voice. There are two variants of adductory spasmodic dysphonia: classic and tonic.

In the tonic variant, the adductory spasms are more constant and sustained than intermittent, so that instead of interrupting the person’s speech, the spasms cause a constant strained or “tight” vocal quality.

what is SLAD-R YT Thumbnail

One Man’s Experience Over Time with SLAD-R

SLAD-R is a surgical alternative to ongoing “botox” injections for treatment of adductory spasmodic dysphonia. The surgery involves intentionally cutting the nerves that close the vocal cords for voice and reconnecting a different nearby nerve supply (reinnervating the nerves).

This surgery requires the patient’s willingness to endure an extremely breathy voice for many months after the procedure, while awaiting reinnervation.

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