Spasmodic (spastic) dysphonia (SD) is considered by some to be a neurologic syndrome and by others a symptom complex of multiple etiologies, neurologic and psychogenic. A case of a 26-year-old female psychiatric nurse with psychogenic SD (PSD) is presented. The dysphonia was alleviated within one session of voice therapy. Psychogenic etiology was established by the author, based on three diagnostic criteria-symptom incongruity, symptom reversibility, and symptom psychogenicity. Seven nationally recognized voice experts listened to audio-recorded samples of the patient's pre- and posttherapy voice during conversational speech. The experts agreed that the dysphonia was psychogenic and characterized it as staccato-like speech, effortful phonation, and interrupted flow of speech; six characterized it with intermittent voice arrests (voice stoppages); five with hoarse-harsh voice; and four with waxing and waning, strained-strangled phonation. These are often described as salient features of SD. Nevertheless, the experts disagreed among themselves as to whether the dysphonia was characteristic of SD and should be labeled as such. The author argues that as long as the voice characteristics and pathophysiologic findings that constitute SD are not well delineated, and as long as the diagnosis of SD is based on symptoms alone, patients with psychogenic or poorly understood voice disorders are likely to be misdiagnosed with organic (neurologic) SD and thus subjected to undue medical treatment. The author also argues that the debate over the etiology of SD can be resolved if SD is considered a neurologic syndrome, PSD a nonorganic phonatory disorder that mimics the syndrome, and if the voice symptoms and pathophysiologic characteristics of SD are well defined and agreed on.
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Acknowledgment: I thank the following voice experts, all speech pathologists and scientists, for their invaluable contribution to this study: Drs. Arnold E. Aronson, Daniel R. Boone, Michael P. Cannito, David E. Hartman, Anat Keidar, Gall B. Kempster, and Christy L. Ludlow. The order of their appearance here does not correspond to the order of their appearance in the body of the manuscript. I also thank Robert W. Bastian, M.D., who referred this interesting case to me and was instrumental in the differential diagnosis of this patient's dysphonia. Special thanks to Drs. A. Aronson, R. Bastian, and D. Hart-man for their critical comments and editorial suggestions on the previous versions of this manuscript. Finally, I thank the patient for giving me permission to use her audio and video recordings for research and academic purposes and for the welfare of other patients. This study was supported in part by National Institutes of Health/ NIDCD grant IR29 DC00591-01Al.
- Psychogenic voice disorders
- Spasmodic dysphonia
ASJC Scopus subject areas
- LPN and LVN
- Speech and Hearing