Speech Problems Spasmodic dysphonia, dysphonia Dysphonia simply means difficulty in speaking, specifically in the phonation of sound.  Dysphonia may occur during puberty when voice changes occur, after a cold, or with sore throat (e.g., hoarseness). However, spasmodic Dysphonia is a voice disorder that affects the normal movement of the vocal cords during speech (i.e., when they come together) and results in a quivery, hoarse, jerky, or groaning voice. The spasms may inhibit sound altogether (i.e., aphonia) or produce periods when there is near normal voice quality. The symptoms tend to worsen during fatigue, stress, and Anxiety and may significantly improve when the patient is relaxed or even singing. The disorder may follow an upper respiratory infection or a recent stressful event. It may also be associated with dystonia (neurological disorder affecting muscle tone), neurological conditions, or other chronic illnesses. Spasmodic Dysphonia tends to affect those between ages 30 and 50, but is also seen in children and adolescents.  Women are more often affected than men. Evaluation by an ENT (Ear, Nose, and Throat) physician and a speech therapist is mandatory before appropriate treatment can begin.