In an interview with the Los Angeles Times, the U.S. Secretary of Health and Human Services nominee Robert F. Kennedy Jr. detailed his decades-long experience with spasmodic dysphonia, including a 2022 surgical intervention in Japan for the implantation of titanium vocal cords.

"My voice doesn't really get tired. It just sounds terrible. But the injury is neurological, so actually the more I use the voice the stronger it tends to get," Kennedy told the Times, discussing the condition that has affected his speech since 1996.

According to Johns Hopkins Medicine, spasmodic dysphonia (SD), also known as laryngeal dystonia, is a voice disorder causing "involuntary spasms in the muscles of the voice box or larynx." Kennedy's symptoms are consistent with adductor spasmodic dysphonia which causes sudden involuntary spasms that trigger the vocal cords to stiffen and slam closed, resulting in a tight, strained, or strangled sound.

The condition most commonly affects women, with onset typically occurring between ages 30 and 50. Kennedy developed symptoms at age 42 while teaching at Pace University School of Law. He underwent Botox injections every 3 to 4 months for approximately 10 years before seeking alternative treatments. "When I opened my mouth, I would have no idea what would come out, if anything," he said, describing his symptoms upon waking during that period.

In May 2022, Kennedy underwent surgery in Kyoto, Japan, where surgeons implanted a titanium bridge between his vocal cords to prevent them from pressing together. This procedure has not received FDA approval in the U.S. Dr. Michael Johns, director of the USC Voice Center, cautions that titanium bridge surgeries haven't been consistently effective or durable, with reports of device fracturing despite being implanted by reputable doctors.

The exact etiology of SD remains unknown, though Johns Hopkins indicates it may be related to central nervous system dysfunction, potentially involving the basal ganglia. 

SD affects approximately 50,000 individuals in North America, though this figure may be conservative due to underdiagnosis and misdiagnosis, according to Dysphonia International. Treatment decisions are based on multiple factors including the patient's age, overall health status, medical history, and how well they can handle specific medicines, procedures, or therapies.