If you followed Robert F. Kennedy Jr.’s presidential campaign last year or tuned in to his confirmation hearings as Donald Trump’s choice to lead the Department of Health and Human Services, you probably noticed his raspy and halting speaking voice.
Read on to learn more about this unusual condition, including symptoms, diagnosis, and treatment.
What Is Spasmodic Dysphonia?
Spasmodic dysphonia, now referred to as laryngeal dystonia, is a rare neurological condition affecting the vocal cords. “It causes involuntary spasms in the vocal folds, leading to a strained, strangled voice, or a voice that is unpredictable,” says Lyndsay Madden, DO, an associate professor of otolaryngology at Wake Forest University School of Medicine in Winston-Salem, North Carolina.
“Speech and voicing are often greatly impacted in people with spasmodic dysphonia and it can make communication quite challenging,” adds Dr. Madden.
- Adductor Spasmodic Dysphonia This is the most common type, in which the vocal cords stiffen and slam shut, causing speech to sound tight and strained.
- Abductor Spasmodic Dysphonia Less common, this type causes the vocal cords to open unexpectedly, which leads to a weak, breathy voice.
- Mixed Spasmodic Dysphonia This rare form combines symptoms of both adductor and abductor types.
The condition is considered rare, affecting approximately 1 in 100,000 people, says Madden.
Symptoms of Spasmodic Dysphonia
Symptoms may include voice changes that sound:
- Breathy and soft, like a whisper
- Strained and tight
- Hoarse
- Broken (because sounds and parts of words are cut off while speaking)
- Shaky or trembling
Causes and Risk Factors for Spasmodic Dysphonia
“The exact cause is not fully understood, but it is thought to involve a combination of genetic and environmental factors. Some cases have been linked to prior upper respiratory infections, stress, or voice overuse, though no single cause has been identified,” says Madden.
“Sometimes the symptoms may be preceded by a psychological trauma — death in the family, for example. In most other cases, the voice problems start insidiously [the symptoms come on slowly] and persist with no clear precipitating cause,” says Edward Damrose, MD, a professor of otolaryngology and an otolaryngologist at Stanford Health Care in California.
Recent work on the underpinnings of the condition suggests that complex neural networks in the cerebral motor cortex, the part of the brain that is responsible for speech, become disorganized, he says.
The condition most often affects women, especially between the ages of 30 and 50 years old. All races and ethnicities appear to be susceptible, says Damrose.
How Is Spasmodic Dysphonia Diagnosed?
“The condition is often underdiagnosed, as many voice conditions are, because most people do not know that there are options for treatment of this condition,” says Madden.
Treatment for Spasmodic Dysphonia
While there is no cure for spasmodic dysphonia, various treatments can reduce symptoms and improve communication.
- Botox injections: Long considered the gold standard of treatment, Botox (a drug made from a toxin that can temporarily weaken or paralyze certain muscles) is injected into the voice box periodically to relax the spasms, says Damrose.
- Voice therapy: A speech-language pathologist can work with you to improve your voice control and help you manage the strain.
- Surgery: Surgery is an option, but few people turn to it because symptoms tend to recur afterward, says Damrose. “Endoscopic surgery to remove some of the vocal cord muscle is a more recent and promising surgical development,” Damrose says.
In a February 2024 interview, Kennedy said that his condition had improved thanks to surgery.
“About six months ago I had a novel surgery that they only do in Kyoto. And it made my voice much better, which you probably won’t believe, but it was much worse than this before,” he said.