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Multiple Sclerosis: Speech and Voice Problems

Normal speech and voice quality depend on complex messaging in the central nervous system. When multiple sclerosis (MS) is part of the equation, nerve impulses can’t always travel where they need to go, and speech and voice quality become impaired. Approximately 25 to 40 percent of people with MS experience these kinds of problems at one time or another.

  • Dysarthria is the term used to describe problems relating to speech production, such as slurring, unclear articulation, and problems with volume control.

  • Dysphonia is the term for problems with voice quality, such as harshness, poor pitch control, excessive nasality, increased breathiness, or hoarseness.

Problems with speech and voice quality can come and go during relapses or periods of extreme fatigue. If you begin to experience any changes that interfere with everyday communication, request a referral to a speech-language pathologist (S/LP).

Individualized therapy techniques can relieve many of these problems, and the sooner you start treatment, the better your outcome is likely to be. Your healthcare professional or the National MS Society (800-FIGHT-MS or 800-344-4867) can refer you to an S/LP with experience in MS.

The S/LP tests the muscles in your mouth and throat that are necessary for speech and evaluates your respiratory function and your ability to control pitch and loudness. He or she also performs a motor speech evaluation to determine if your breathing, voice production, articulation of words, and flow of speech are working appropriately together.

And lastly, the S/LP completes a communication profile to figure out what your communication needs are at home and at work — for example, checking to see if you talk mostly in one-on-one situations with people who know you well or if you need to be able to communicate in large, noisy groups. Ultimately, the S/LP’s goal is to ensure that you can communicate effectively with others whenever and wherever you want to.

After the S/LP has identified whatever problems you’re having, he or she develops an individualized treatment program for you, typically consisting of a daily exercise routine for your lips, tongue, soft palate, vocal cords, and diaphragm. He or she may also give you some strategies to compensate for any problems you’re having with speech clarity.

If necessary, the S/LP may also recommend certain medications to help manage the problems:

  • An antispasticity medication like Lioresal (baclofen) or Zanaflex (tizanidine) may help if your problems with voice quality and loudness are caused by spasticity.

  • If tremor in your vocal cords, jaw, lips, or tongue is causing the problem, the doctor may recommend a medication such as Klonopin (clonazepam).

  • If fatigue is contributing to your problems with voice control and volume, you may find amantadine, Provigil (modafinil), or Nuvigil (armodafinil) useful.

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