Robert F. Kennedy Jr., President Trump’s nominee to head the U.S. Department of Health and Human Services, exhibits a raspy, wavering voice due to spasmodic dysphonia, a rare neurological disorder causing vocal cord muscle spasms.
Kennedy has openly discussed the condition’s impact, expressing dissatisfaction with his voice and acknowledging the burden it places on listeners. He’s noted that while his voice doesn’t tire easily, its quality is poor. He attributes this to the neurological nature of the condition, suggesting that increased vocal use strengthens it.
This article provides an overview of spasmodic dysphonia’s prevalence, causes, and treatments.
Understanding Spasmodic Dysphonia
Spasmodic dysphonia (SD) is a rare disorder causing involuntary voice box movements, according to Saul Frankford, an assistant professor at the University of Texas at Dallas who has studied the condition. Its prevalence is approximately [number]%.
Two main SD types exist. Adductor spasmodic dysphonia, Kennedy’s type, involves overly tight vocal fold closure during speech, leading to raspiness, creakiness, and voice breaks. The less common abductor spasmodic dysphonia causes sudden vocal cord opening, resulting in a breathy voice.
SD is sometimes called laryngeal dystonia. This relates to other dystonias like writer’s cramp and neck dystonia, all characterized by involuntary muscle contractions during movement, such as finger, hand, or forearm spasms.
Causes of Spasmodic Dysphonia
SD typically emerges in the 40s or 50s (Kennedy’s diagnosis was in 1996), and its cause remains unclear. Frankford describes its onset as often sudden. However, some patients report preceding upper respiratory infections or periods of stress and anxiety as potential triggers.
A genetic component exists, though its exact contribution is uncertain. Frankford estimates that 10% to 20% of individuals with SD have affected family members.
Impact on Vocal Activities
Spasmodic dysphonia is a task-specific dystonia primarily affecting regular speech. Other vocalizations, such as laughing, crying, whispering, and sometimes singing, are less likely to be impacted.
Diagnosing Spasmodic Dysphonia
SD diagnosis presents challenges due to its rarity and resemblance to other voice disorders. An accurate diagnosis often takes four to five years. The condition’s overlap with muscle tension dysphonia adds to diagnostic difficulty.
The lack of visible physical abnormalities complicates diagnosis. There are no detectable structural issues on MRI scans. Diagnosis often involves speech-language pathologist assessments of voice production and quality, and potentially, a doctor examining vocal folds via a small tube inserted through the nose into the voice box.
Cure and Treatment for Spasmodic Dysphonia
SD is a chronic, incurable condition, though its severity fluctuates with stress and fatigue levels.
Treatment Options
Botox injections into the larynx muscles are the standard treatment. This weakens the muscles, improving vocal quality, albeit temporarily. Side effects include breathiness. Retreatment is needed every two to five months. Kennedy reported receiving Botox every four months (in 2005, on The Diane Rehm Show).
Research into drug therapies and surgical nerve severing is ongoing, but surgical outcomes are inconsistent. Vocal therapy may offer some benefit, particularly for muscle tension dysphonia, but not for SD itself.
Living with Spasmodic Dysphonia
SD’s impact extends to mental health, with studies indicating high rates of anxiety and depression, and a heightened risk of suicide among those affected.
Communication difficulties associated with the condition significantly affect quality of life, often leading to social withdrawal. Frankford emphasizes that SD is a neurological disorder, not a reflection of cognitive ability or character, and that those affected should not face ridicule.
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