Brief Answer: A vocal cord examination by ENT is recommended Detailed Answer: Hello, spasmodic dysphonia does not present the way you have described history. Your history goes more in favour of Myasthenia in which as the day progresses, the voice fatigues. By the evening, patient is barely able to produce voice loudly. But Myasthenia gravis is a rare auto immune disease in which there is problem with the neuromuscualar transmission and the diagnosis is usually made by anti–acetylcholine receptor (AChR) antibody test. You need to consult a neurologist for that. Drooping of upper eye lids is the most common initial symptom. Otherwise there are various causes of symptoms described by you and an ENT is the best person to diagnose which requires examination of vocal cords by endoscopy/stroboscopy. So, Please visit an ENT and he/she after examining can refer you to a speech-language pathologist if need be. Without visualization of vocal cords in a voice disorder, it is not advisable to guess a diagnosis. Take care. Regards

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