The confirmation hearing for Robert F. Kennedy Jr. as head of the US Department of Health and Human Services started Wednesday, with people around the country tuning in to hear the 71-year-old answer pressing questions from lawmakers. But while many are closely following the hearing to learn more about the nominee’s plans for the future of American healthcare, several have flagged the gravelly sound of RFK Jr.’s voice.
Kennedy has spoken openly about this in the past. He has a condition called spasmodic dysphonia, which causes his voice to have noticeable tremors – and he’s not happy about it. Kennedy told the Los Angeles Times in an April 2024 article that he “can’t stand” the sound of his “terrible” voice. “If I could sound better, I would,” he added.
Kennedy said he first noticed a change in his voice in 1996, and suggested that the flu vaccine was “at least a potential culprit” in the development of his spasmodic dysphonia. (However, he acknowledged to the publication that there’s no proof of this. RFK Jr. has also been heavily involved in the anti-vax movement.)
But his hearing has put the condition back in the spotlight, raising beyond his qualifications for the US government. In fact “why is RFK’s voice so gravelly?” is a breakout term on Google. Ahead, we asked doctors to weigh in on RFK Jr.’s voice and everything else there is to know about his condition – from what causes spasmodic dysphonia to how it’s treated.
Experts Featured in This Article:
Phillip Song, MD, is the director of the division of laryngology at Massachusetts Eye and Ear and an assistant professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School.
Amid Mehdizadehr, MD, is an otolaryngologist and laryngologist at Providence Saint John’s Health Center in Santa Monica, CA.
What Is Spasmodic Dysphonia?
Spasmodic dysphonia is a disorder that affects the voice muscle in the larynx, which is also known as the voice box, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).
Speech involves air being pushed from your lungs between the vocal folds. Those cords then vibrate and create the sound of your voice. But spasmodic dysphonia causes the muscles inside the vocal folds to spasm, interfering with those vibrations, explains Phillip Song, MD, director of the division of laryngology at Massachusetts Eye and Ear and assistant professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School.
Spasmodic dysphonia is a chronic condition that can develop suddenly, and typically continues through a person’s life, according to NIDCD. That said, it’s considered a rare disorder. About 50,000 people in North America have spasmodic dysphonia, according to Dysphonia International.
Why Does RFK Jr.’s Voice Sound Raspy?
Everyone experiences spasmodic dysphonia differently, but the condition usually has a noticeable impact on the voice. “The voice comes out very strained,” Dr. Song says. “There are also voice breaks.”
Spasmodic dysphonia isn’t usually painful, although it can be uncomfortable for patients who have a severe form of the condition. “It can feel like someone is squeezing your throat,” Dr. Song explains. “Sometimes it also feels like there’s a lump in the throat.”
People with spasmodic dysphonia may also experience symptoms more after they speak a lot, per Dr. Song. That makes the condition challenging for those with “vocally-demanding careers,” like teachers and politicians, says Dr. Song.
What Causes Spasmodic Dysphonia?
While Kennedy suggested that his spasmodic dysphonia was caused by the flu vaccine, there is no evidence to back this up. Dr. Song says the condition is usually considered idiopathic – meaning, doctors don’t know exactly why some people develop it.
However, spasmodic dysphonia is thought to be due to abnormal functioning in an area of the brain called the basal ganglia, which helps coordinate muscle movement throughout the body, Dr. Song says. Abnormalities in other areas of the brain, including some areas of the cerebral cortex, which controls and coordinates commands to muscle, may also play a role, per the NIDCD. “The way that voice and speech is conducted throughout the brain is complicated,” Dr. Song says. “There are a lot of connections.”
But spasmodic dysphonia could also be caused by several factors, says Omid Mehdizadeh, MD, an otolaryngologist and laryngologist at Providence Saint John’s Health Center in Santa Monica, CA. “Some believe it could be due to a central [brain] injury,” he says. “There may also be a genetic trait.”
How Is Spasmodic Dysphonia Treated?
People with spasmodic dysphonia have several treatment options available. However, Dr. Mehdizadeh says the “gold standard” of treatment is getting small amounts of botulinum toxin (Botox) injected directly into the muscles of the larynx. “This helps those vocal folds that are spasming to relax,” he explains.
Dr. Song says the shots only take about five minutes, and are given to patients every three to six months or as needed. “A lot of folks will come in on a schedule,” he says. “People with vocally-demanding careers come in regularly. I have a lot of teachers in my practice who will come in [for injections] near the end of summer break to try to get ready before the school year.”
While Botox injections are the main treatment doctors who treat spasmodic dysphonia recommend, Dr. Song recently published research that showed sodium oxybate, an oral medication that’s also used to treat narcolepsy, may help with symptoms, too.
Vocal therapy may also help people learn to work with their condition, Dr. Song says. But, unfortunately, spasmodic dysphonia tends to be a lifelong condition. “It will generally not go away on its own,” Dr. Mehdizadeh says.
Korin Miller is a writer specializing in general wellness, health, and lifestyle trends. Her work has appeared in Women’s Health, Self, Health, Forbes, and more.
