As Robert F. Kennedy Jr. answered questions during the Senate confirmation hearing for his nomination to head the U.S. Department of Health and Human Services, many people have noticed his voice sounds quivering and gravely.
Kennedy has a condition called spasmodic dysphonia, a neurological disorder that impacts the muscles in the voice box, also known as the larynx, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).
“I can’t stand my voice,” Kennedy told NBC News in 2023.
In the 1990s, Kennedy learned he had spasmodic dysphonia, according to NBC News. The rare condition causes uncontrolled spasms in the muscles responsible for coordinating the vocal folds in the larynx, says Dysphonia International. These involuntary muscle movements can cause a person’s voice to sound weak, break or have a “strained/strangled quality,” according to the organization.
About 50,000 people in North America live with spasmodic dysphonia, according to Mount Sinai, and it most often starts in middle age. More women than men have the condition, and people who do a great deal of speaking are more likely to be diagnosed with it, Mount Sinai says.
What causes spasmodic dysphonia?
Experts believe that disruptions in the basal ganglia, a region the brain that assists muscle coordination, can contribute to spasmodic dysphonia, NIDCD says. Emerging research has found that other areas of the brain — such as the cerebral cortex, which also play a role in muscle control and processing sensory information — could also be involved in spasmodic dysphonia.
While it's possible a gene mutation can contribute to spasmodic dysphonia, researchers have yet to discover a gene specifically related to it, the NIDCD notes.
How is it diagnosed?
Otolaryngologists — also known as ear, nose and throat doctors, or ENTs — normally diagnose spasmodic dysphonia. They perform an examination where they insert a tube with a light through the nose and into the throat to examine the vocal fold structure and their mobility during speech, the NIDCD says. This is called a fiberoptic nasolaryngoscopy, and it's a common way for doctors to see the voice box.
Treatments
While there is no single therapy that effectively treats spasmodic dysphonia, some interventions can help people improve their voices. For example, Botox injected into the larynx muscles can block the nerve messages sent to the muscles. This can bolster the voice for up to four months, the NIDCD says.
Some people with mild spasmodic dysphonia might hear an improvement in their voice with vocal therapy while others might pair Botox injections with vocal therapy. If other interventions do not work well, people might opt for surgery, the NIDCD notes.
Kennedy said on The Diane Rehm Show in 2005 that he received Botox shots into his vocal cords every four months, according to NPR. In 2023, he told NBC News he underwent surgery in Kyoto, Japan where doctors placed a “titanium bridge” in his vocal folds.
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