Spasmodic dysphonia is a voice disorder caused by involuntary muscle spasms in the voice box (larynx). These spasms make the vocal cords contract too much or in an uncoordinated way. When this happens, your voice might sound strained, choppy, or even “pressed” as if you’re struggling to speak. Some people with this condition may notice that their voice sounds different when they speak normally versus when they sing or hum.

Doctors diagnose this condition by listening carefully to your speech and examining your vocal cords with a tiny camera (fiberoptic laryngoscopy). They might ask you to do tasks like sustain a vowel sound or count in a specific way. These tests help them tell the difference between the common type (adductor spasmodic dysphonia) and a less common type (abductor spasmodic dysphonia), as each affects the voice in slightly different ways.

Treatment is usually done in the doctor's office by injecting a small amount of Botox into the overactive muscles. For people with adductor spasmodic dysphonia, Botox is placed into muscles that make the vocal cords come together too tightly. For those with abductor spasmodic dysphonia, the injection goes into a muscle that usually helps open the vocal cords. These injections help relax the muscles, making your speech smoother for several months. In cases where Botox isn't enough or if a patient prefers a different approach, surgery might be considered as an alternative treatment.

A vocal tremor occurs when one's voice shakes or quivers while speaking or holding a note. This trembling happens because the vocal cords vibrate irregularly, causing the voice to sound unstable. The tremor might change in speed or strength and can sometimes be seen along with other voice issues. It is important to note that vocal tremors can appear on their own or in association with different conditions, such as essential tremors or Parkinson's disease.

Doctors use special video techniques like stroboscopy or high-speed imaging to look at how your vocal cords move when you speak. These tools help capture the rapid changes and irregularities that cause the trembling. Treatment options depend on the underlying cause but may include voice therapy, medications, or Botox injections. These approaches aim to reduce the shaking so that you can speak more steadily, and the treatment choice is based on how severe the tremor is and what might be causing it.

Some neurological conditions, such as Parkinson's disease, ALS (amyotrophic lateral sclerosis), and myasthenia gravis, can affect the nerves that control the muscles in your voice box. When these nerves don't work properly, it can lead to a weak, soft, or hoarse voice and problems swallowing or speaking clearly. These voice changes might sometimes be the first sign of a more significant neurological issue, even before other symptoms appear.

In the doctor's office, specialists use tools like video laryngoscopy and sometimes electromyography (a test that measures muscle electrical activity) to examine how well your vocal cords are moving. Treatment typically involves working closely with a team including neurologists, ear–nose–throat doctors, and speech therapists. They often recommend voice therapy to help strengthen your vocal muscles and improve your speaking clarity. In some instances, if voice therapy alone isn't enough, doctors might suggest injections or surgery to support better vocal cord function. The improvement you see depends on the overall progress of the neurological condition, but early and targeted treatment can help you maintain better communication and quality of life.