THE Robert Kennedy JrTrump’s pick to lead the Department of Health, said he suffers from spasmodic dysphonia.

This is a voice disorder characterized by involuntary spasms in the muscles that control the vocal cords. This causes difficulty in speaking with the voice often “breaking”.

Spasmodic dysphonia most often develops in the 30s or 40s and can be life-changing, especially for those whose careers depend on speech.

“Most people take their voice for granted until they don’t,” Pryor Brenner, an otolaryngologist in Washington, told the Washington Post. “It can be very discouraging. People don’t feel comfortable talking or don’t want to talk. They are ashamed. It has a huge impact because they can’t express themselves.”

What causes spasmodic dysphonia?

Scientists agree that the disorder is neurological, but don’t know its exact cause, according to Dysphonia International. Researchers are trying to determine which part of the brain is involved and whether there may be a genetic predisposition, according to the agency.

Some cases can also be caused by a viral illness, such as a cold or flu, or a traumatic life event, such as the death of a loved one, Brenner said. “An incredibly stressful life event can trigger it,” he said.

Andrew Tritter, an otolaryngologist at UTHealth Houston, said such cases are rare, but they do happen. “I had a patient who woke up with it after having a hysterectomy. Her voice was terrible and the situation became chronic.”

Tritter said that for people with spasmodic dysphonia the condition can become very distressing. “They may not understand or be heard or be asked to repeat what they are saying all the time.”

There are also idiopathic cases, which appear suddenly for no apparent reason. “It just happens,” Brenner said.