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2 results

  • Chapter 11 - Botulinum Neurotoxin Therapy of Laryngeal Muscle Hyperactivity Syndromes

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 82-88

  • Summary

    Spasmodic dysphonia is a focal dystonia characterized by task-specific, action-induced spasm of the vocal cords.

    There are three types of spasmodic dysphonia: Adductor spasmodic dysphonia (ADSD) is characterized by a strained-strangled voice quality and intermittent voice stoppage or breaks, resulting in a staccato-like voice, caused by overadduction of the vocal folds.

    Abductor spasmodic dysphonia (ABSD) is characterized by intermittent breathy breaks and associated with prolonged abduction folds during voiceless consonants in speech.

    Mixed-type spasmodic dysphonia has features of both.

    The efficacy of botulinum neurotoxin (BoNT) injection in the treatment of spasmodic dysphonia has been proven. This chapter enumerates the muscles involved in each type of spasmodic dysphonia, diagrams and describes different approaches for injection, along with the use of guidance techniques such as laryngoscopy and electromyography, and tabulates dose ranges of the different types of BoNT for each muscle.

  • Selective lateral laser thyroarytenoid myotomy for adductor spasmodic dysphonia

  • A Hussain, M Shakeel
  • Journal:
    The Journal of Laryngology & Otology / Volume 124 / Issue 8 / August 2010
    Published online by Cambridge University Press:
    29 April 2010, pp. 886-891
    Print publication:
    August 2010
  • Objective:

    Selective lateral laser thyroarytenoid myotomy is a conceptually sound, simple, minimally invasive, repeatable and predictable new surgical procedure for treating adductor spasmodic dysphonia. This paper aims to introduce and describe the surgical technique, and to present a clinical case series and its outcomes.

    Study design:

    A prospective, clinical case series treated with selective lateral laser thyroarytenoid myotomy, with follow up of 2.5 years.

    Method:

    Pre- and post-operative data were collected prospectively for patients undergoing selective lateral laser thyroarytenoid myotomy. These data included patient demographics, previous interventions for adductor spasmodic dysphonia, technical aspects of surgery and clinical outcome. Outcome data included clinical assessment, voice handicap index, need for further intervention, and patient satisfaction assessed by subjective improvement (detailed subjectively by the patients themselves and objectively using the Glasgow benefit inventory).

    Results:

    Four patients (two men and two women; mean age 65 years; age range 41–80 years) were included. The mean duration of adductor spasmodic dysphonia was 11 years. All patients had previously been treated with botulinum toxin A. All patients reported improvement in voice quality, fluency, sustainability and elimination of voice breaks over 2.5 years' follow up. Clinical assessment revealed no alteration in mucosal wave, and complete relief of hyperadduction was observed on phonation. No patients required supplementary botulinum toxin treatment during follow up.

    Conclusion:

    Selective lateral laser thyroarytenoid myotomy seems to represent a curative procedure for adductor spasmodic dysphonia, a chronic, debilitating condition. This procedure is conceptually simple, minimally invasive and repeatable. It also seems to offer a safe and lasting alternative to botulinum toxin therapy.