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Spasmodic Dysphonia: Accommodations for the Workplace

Learn more about this specific speech impairment

From the desk of Teresa Goddard, M.S., Lead Consultant – Assistive Technology Services

Spasmodic dysphonia is a rare neurological disorder affecting the movement of the vocal cords during speech. It is a type of focal dystonia in which involuntary spasms affect movement of the muscles that are used to vibrate the vocal folds to produce speech sounds. The vocal folds are also known colloquially as “vocal cords.” There are three types: the adductor type; the abductor type; and the mixed type, in which elements of both are present.  All types cause difficulty using one’s voice to speak, although the adductor type tends to result in a strained voice, while the abductor type tends to cause excessive breathiness when speaking.  The typical age of onset is between 30 and 50. There is no cure at present, but there are treatments that can help to manage the symptoms and enhance communication.

Treatment options include voice therapy, surgery, and injections of botulinum toxin.  A combination of injection therapy and voice therapy is not an uncommon approach. Leave may be needed for medical management involving botulinum toxin injections, as patients may need to travel some distance to reach a qualified provider. The injections typically need to be repeated, as the effects tend to wear off over a period of three to four months. Voice therapy provided by a speech language pathologist is more likely to be available locally and may require either leave or a modified schedule, depending on availability and the individual’s treatment plan. Voice therapy is not usually used alone except in mild cases. However, a speech language pathologist may be involved in the diagnostic stage, regardless of severity of symptoms.  Surgery is not usually attempted unless other treatment methods prove unsuccessful.

In addition to leave and modified schedules to seek treatment, employees may benefit from accommodations to enhance communication and improve their access to meetings and trainings. Some strategies that may improve access include appropriate turn-taking and holding meetings in quiet areas. Some individuals may choose to use assistive technology such as amplification or speech-generating devices, but this is a personal choice.  Amplification can make the person’s voice louder, but amplification alone cannot change qualities such as hoarseness and breathiness that can make a person’s speech challenging to understand. In contrast, using a speech-generating device may allow for communication that is clear and easy to understand, but some users would prefer to use their own natural voice, or at most amplification. Likewise, accommodations for telephone use may be beneficial, but the individual should be consulted as to the type of accommodation that they find helpful. Options include outgoing amplification, hearing carryover TTY, use of speech-to-speech relay services, speech-generating devices where desired and beneficial, and using other methods such as instant messaging and email when feasible.

Counseling and support group participation may also help with adjustment to living with spasmodic Dysphonia as well as stress. Both online and in-person support groups are available through the National Spasmodic Dysphonia Association (NSDA). Employees may benefit from accommodations such as modified schedules and modified policies that allow them to access these resources. 


American Speech-Language-Hearing Association (ASHA). (2016) Spasmodic Dysphonia Retrieved October 5, 2016, from

Dystonia Medical Research Foundation (DMRF). (2016) Spasmodic Dysphonia/ Laryngeal Dystonia Retrieved October 5, 2016, from

National Institute on Deafness and Other Communication Disorders (NIDCD). (2014) Spasmodic Dysphonia Retrieved October 5, 2016, from 

National Spasmodic Dysphonia Association (NSDA) (2016). Spasmodic Dysphonia. Retrieved October 5, 2016, from