Megan is a 39-year-old nurse with moderate dysphonia and intermittent breathy breaks on voiceless sounds; voice is normal when she laughs. Which diagnosis is most likely?

• A. Unilateral vocal fold paralysis
• B. Adductor spasmodic dysphonia
• C. Abductor spasmodic dysphonia
• D. Muscle tension dysphonia

Answer: (C)

This pattern points to abductor spasmodic dysphonia. In this condition, the vocal folds involuntarily move apart (abduct) during speech, causing brief, breathy breaks as you try to produce consonants or vowels. Those breaks are often most noticeable on sounds that are voiceless, when the vocal folds should be held apart anyway, and the voice can sound relatively normal during laughter, when the laryngeal pattern changes and closure can briefly improve.

Unilateral vocal fold paralysis would typically give a more constant breathiness and reduced closure, not the episodic breathy breaks tied to voiceless sounds. An adductor form would produce breaks on voiced sounds (like vowels) due to over-closure rather than on voiceless segments. Muscle tension dysphonia tends to cause a more global, persistent hoarseness with neck tension rather than the characteristic intermittent, sound-specific breaks.