two people engage in conversation word bubbles, but one has a speech problem, and their world bubble is melting

Speech Problems in Myasthenia Gravis

The key symptom of myasthenia gravis (MG) is muscle weakness that gets worse after activity. This usually gets better after rest. Certain muscles can be affected by the disorder, including the muscles that control talking and swallowing. The amount of muscle weakness can vary among people living with MG.1

Speech problems can occur in MG due to this muscle weakness. Knowing more about these problems ahead of time can help you manage these symptoms if they occur.

Common symptoms

Symptoms of MG can be subtle and not always immediately recognized as MG. Voice and speech-related symptoms can include:2

  • Hoarseness
  • Vocal fatigue
  • Trouble controlling voice pitch
  • Hypernasal voice
  • Slurred speech
  • Monotone voice
  • Trouble swallowing
  • Weakness of jaw muscles

What problems may occur?

Several speech problems can occur with MG, including:2-4

  • Dysarthria
  • Dysphonia
  • Hypophonia

Dysarthria is when someone has trouble forming words. This often happens with those who have had a stroke. Consonants might not be correct, and speech can be hard to understand. It occurs because of muscle weakness. It can affect the tongue, voice box, or the surrounding muscles.1,5

Dysphonia is a voice disorder usually caused by problems that affect vocal cord vibration. It can cause a hoarse, weak, or strained voice. The symptoms of dysphonia may not be the same all the time.6

Hypophonia is a low volume of voice. This is often due to the lack of coordination in the vocal muscles. It can be caused by a variety of conditions, including MG.4

What is the cause?

Muscles in the pharynx, larynx, and esophagus may be affected by MG. These muscles control talking and swallowing. When these muscles become fatigued, they become weak. This causes them to not work as well, causing speech problems.2,3

The speech problems are symptoms of the underlying myasthenia gravis. While MG does not always affect these muscles, it does in some people. These speech and voice symptoms can change throughout the day. They often get better after a period of rest.2,3

How are they treated?

Treating the underlying MG helps to treat the associated speech problems. There are many different kinds of treatments for MG, including:1

  • Thymectomy – Removal of the thymus gland, which can be abnormal in those with MG
  • Anticholinesterase inhibitors – These drugs slow the breakdown of acetylcholine, which is the chemical messenger that nerves release to tell muscles to contract
  • Immunosuppressant drugs – These drugs work to calm an overactive immune system, which is common in MG
  • Plasma exchange and intravenous immunoglobulin – These treatments work quickly to improve serious muscle weakness in people with severe MG

Your doctor will talk with you about which treatments might be best for your symptoms.

Things to consider

Some symptoms of MG like a hoarse voice may not seem worrisome at first. If it persists, talk with your doctor. Speech symptoms may not be the first thing you or your doctor think of with MG. Together, you can find a cause and figure out the best treatment for your situation.

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