Voice Disorders

I have been diagnosed with having ADSD, MTD and Laryngeal Reflux disorders. I have never been diagnosed with bilateral voice cord paresis at least not to this point.

I think MTD and Reflux are just part of the diangosis of SD. I don't know maybe I am wrong, just thought I'd give my opnion. If I can be of any assistance, please let me know.

P.S. Please email me privately, I'd like to know more about your website, I think I might allow you to post my story.

I know you're an attuned guy since I've met you in person at two major symposiums but the question you are asking has to do with more than multiple vocal disorders. It has to do with multiple, related disorders/conditions, some of which affect the voice and become "dysphonias" and some of which are just "related."

Touching on your example, "laryngeal reflux" (I've never heard it called that but it makes sense) is basically a gastro-esophageal *thing* that would affect the larynx. Just because someone has GERD or some kind of reflux does not make it a "voice disorder." It originates elsewhere and often causes or contributes to a voice disorder. If it became a "voice disorder," it would be called something different. It might be called "Spasmodic Dysphonia." So many people with SD also have reflux. Definitely related, but NOT a vocal disorder in its own right. People can have reflux without having dysphonia. "Dysphonia" is, by technical definition, a vocal/speech problem. There are numerous kinds of dysphonia.

"Paresis" (either bi-lateral or unilateral) is, by definition, a paralysis of the vocal cord(s) - obviously interferring with pure speech. If I can believe my sources, it has non-neurological causes (ie: non-dystonic). It's more functional. With "paresis," there is paralysis with no spasming/straining. If you think about the definition, "paresis" and Spasmodic Dysphonia *seem* to be mutually exclusive. By definition, SD is "spasmodic." Translated as spasms. If someone has "paresis," there are no spasms. Just paralysis. The two descriptive terms describe two different forms of "dysphonia" (speech/vocal problems) which, to my understanding, cannot exist in the same human. You either have one or the other, or something else.

The "dysphonia" that I've seen and heard alot, which often exists in SD'ers (or mimics SD) and is so difficult to separate from SD (even for voice professionals) is Muscle Tension Dysphonia. Based on what I have read (and often heard/seen), that is a vocal disorder caused by vocal overload and abuse. MTD and SD sometimes appear in the same human. People can have both and, if they do, they're difficult to separate. There are some people on this BB who are dealing with their MTD (who thought they had SD and didn't or they have a combo of SD-MTD).

So, not to be evasive, but the answer to your question is that sometimes people can have multiple forms of dysphonia (vocal disorders) but certain vocal disorders are mutually exclusive, by definition, and certain things associated with SD are not vocal disorders, but are related.

Hope I haven't thrown too much *mud* onto this issue. I'm sure you remember the fine doctors in Michigan las t March who talked about a whole lot of symptoms and conditions that get confused with SD and how very difficult it is to diagnose true-SD and how sometimes they just have to eliminate other possibilities. The person you refer to who was diagnosed with alot of things may not have met the right vocal professional yet...someone who fully understands their case.

Write me back on my private e-mail if this doesn't make sense. I can't diagnose people but I'm relatively clear on the classic definition(s) and descriptions of the conditions you are asking about. The answer to your question is: ..."yes" and "no" and "it depends on the circumstances." Hope that helps a little. Also, if it would help, please have the person who asked you contact me. I may be able to explain it better off the BB.

Not to be too picky--well, I guess I am being picky--I'd like to address a few issues in your post.

Paresis means a weakness or partial paralysis. It is neurologic, not functional. Functional means behavioral or psychogenic. A paresis can originate in the central nervous system, i.e. the brain, as in a stroke, or it can originate in the peripheral nerve, as in trauma or viral infection. SD and other dystonias, on the other hand, originate only in the brain.

A paresis of the vocal cord would tend to oppose adductor SD, but they are not mutually exclusive. I know this because I have both conditions simultaneously--paresis of the right vocal cord and ADSD. You can think of botox as causing an artificial, temporary paresis of the vocal cords. The more severe the paralysis, the more breathy you are (and the less likely you are to spasm). As the botox begins to wear off, the spasms return, but you begin to spasm before the botox wears off completely.

I completely agree with your excellent discussions of GERD and MTD.

This post is a little off topic, but I couldn't resist the opportunity to get more information. In your post, you mention that a peripheral nerve can be affected by a viral infection. I have had some episodes recently which make me think I may have been affected by something like this. Can you tell me where/how I would find out further information about nerves and viral infections?

(BTW, the "episodes" I mention involve a highly painful, intense burning pain - the first one being down both arms (alternately and together.) The condition lasted about 48 hours - of course over a weekend. It happened again, less severe and in the neck, several months later.)

Thanks for any help you can give me!

And thank you for the feedback. :) I've also talked to about 6 people (all women) on the phone, who had the surgery and sounded GREAT! They ALL said that they would do it again in a heartbeat! My doctors in Nashville advised me against the surgery. I think I may go anyway to LA (I am now back living in Northern Califoria) and at least have an assessment. The Botox works for me also quite well. I also have Botox in the back of my neck for a head tremor caused by the Essential Tremor. So, even though, it becomes a hassle getting injections everytime I turn around (it seems anyway), the injections did give me back my life. Perhaps with the Essential Tremor and the SD.........I won't be able to have the surgery at all. But, I'm thankful for what relief I can also get with the Botox. (sounds like I'm getting cold feet). But, as a counselor and being my own sole support I can't afford to lose my voice. I don't think I can take that chance. I don't know..........we'll see. :) Thank you for your message. And, I hope all goes better for the guys that the surgery didn't go well for.