eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Spasmodic Dysphonia: Workup

Author: Michael J Pitman, MD, Assistant Professor, New York Medical College; Director, The Voice and Swallowing Institute; Director, Division of Laryngology, Department of Otolaryngology, New York Eye and Ear Infirmary
Coauthor(s): Ameet R Kamat, MD, Staff Physician, Department of Otolaryngology, New York Eye and Ear Infirmary; Darius Bliznikas, MD, Staff Physician, Department of Otolaryngology, Wayne State University School of Medicine; Soly Baredes, MD, Associate Professor of Clinical Surgery, Chief, Section of Otolaryngology-Head and Neck Surgery, Director, Division of Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Contributor Information and Disclosures

Updated: Feb 11, 2009

Workup

Laboratory Studies

Laboratory tests are generally unnecessary.

Imaging Studies

CT scanning with gadolinium or MRI: Reserve brain imaging for patients with focal findings upon neurologic examination that are beyond the distribution of spasmodic dysphonia (SD).

Other Tests

  • Neurologic examination
    • The occurrence of other neurologic signs not associated with other dystonias or tremor suggests that spasmodic dysphonia (SD) is secondary to another disease process.
    • The neurologic examination may also reveal signs of other neurologic disorders that may be misconstrued as spasmodic dysphonia (SD).
  • Perceptual analysis
    • Grade, roughness, breathiness, atonicity, and strain (GRBAS) is the evaluation system currently used to evaluate perceptual judgment. GRBAS involves a scale of 0-3 (0 = normal or absence of deviance; 1 = slight deviance; 2 = moderate deviance; 3 = severe deviance).
    • Conversational speech or the reading of a passage is rated. The classic perceptual sign of spasmodic dysphonia (SD) is abnormal voice quality that is heard in contextual speech but not necessarily in singing, whispering, laughing, falsetto voice, or crying.
    • Sentences that elicit adductor breaks when spoken include the following:
      • "I eat apples and eggs."
      • "The dog dug a new bone."
      • "We mow our lawn all year."
      • "Early one morning, a man and a woman were ambling along a 1-mile lane, running near Rainy Island Avenue."
    • Sentences that elicit abductor breaks when spoken include the following:
      • "How high is Harry's hat?"
      • "Did he go to the right or to the left?"
      • "When he comes home, we'll feed him."
      • "He saw half a shape mystically cross a simple path, at least 50 or 60 steps in front of his sister Kathy's house."
  • Acoustic analysis
    • Acoustic measures reflect the status of vocal function. Standard deviation of the fundamental frequency or jitter (measured in ms) and amplitude modulation or shimmer are significantly higher in patients with spasmodic dysphonia (SD).
    • The signal-to-noise ratio is generally lower in patients with spasmodic dysphonia (SD) than in healthy control subjects.
  • Aerodynamic analysis
    • Aerodynamic analysis of voice production includes the measurement of airflow and air pressure and their relationships during phonation.
    • In adductor spasmodic dysphonia (SD), mean airflow rates range from normal to extremely low.
    • In abductor spasmodic dysphonia (SD), mean phonatory airflow rate is generally above normal, with bursts of airflow occurring with the abductor spasm.
    • Subglottic pressure measures were estimated to be higher than normal in patients with adductor spasmodic dysphonia (SD).
  • Electromyographic analysis
    • In 2001, Hillel demonstrated that all the laryngeal muscles are involved in spasmodic dysphonia using examination with hooked wired electrodes.15
    • Either abductor or adductor muscle spasms are believed to predominate, resulting in the corresponding symptoms.
    • EMG is generally not used in diagnosing spasmodic dysphonia (SD).
  • Subjective evaluation by patient
    • The purpose of a subjective self-evaluation is to determine the deviance of voice quality and the severity of disability or handicap in daily professional and social life and to determine the possible emotional repercussions of the dysphonia.

Diagnostic Procedures

  • Videolaryngostroboscopy
    • Videolaryngostroboscopy is the main clinical tool used in determining the origin of voice disorders. Abductor and adductor spasms can be visualized during voice breaks.
    • This procedure can also be used to assess the quality of vocal fold vibration to evaluate treatment effectiveness.

More on Spasmodic Dysphonia

Overview: Spasmodic Dysphonia
Workup: Spasmodic Dysphonia
Treatment: Spasmodic Dysphonia
Follow-up: Spasmodic Dysphonia
Multimedia: Spasmodic Dysphonia
References
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References

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  2. Dedo HH. Recurrent laryngeal nerve section for spastic dysphonia. Ann Otol Rhinol Laryngol. Jul-Aug 1976;85(4 Pt 1):451-9. [Medline].

  3. Biller HF, Som ML, Lawson W. Laryngeal nerve crush for spastic dysphonia. Ann Otol Rhinol Laryngol. Sep-Oct 1983;92(5 Pt 1):469. [Medline].

  4. Aronson AE, De Santo LW. Adductor spastic dysphonia: three years after recurrent laryngeal nerve resection. Laryngoscope. Jan 1983;93(1):1-8. [Medline].

  5. Isshiki N, Haji T, Yamamoto Y, Mahieu HF. Thyroplasty for adductor spasmodic dysphonia: further experiences. Laryngoscope. Apr 2001;111(4 Pt 1):615-21. [Medline].

  6. Blitzer A, Brin MF, Fahn S, Lovelace RE. Localized injections of botulinum toxin for the treatment of focal laryngeal dystonia (spastic dysphonia). Laryngoscope. Feb 1988;98(2):193-7. [Medline].

  7. Chhetri DK, Mendelsohn AH, Blumin JH, Berke GS. Long-term follow-up results of selective laryngeal adductor denervation-reinnervation surgery for adductor spasmodic dysphonia. Laryngoscope. Apr 2006;116(4):635-42. [Medline].

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  27. Allegretto M, Morrison M, Rammage L, Lau DP. Selective denervation: reinnervation for the control of adductor spasmodic dysphonia. J Otolaryngol. Jun 2003;32(3):185-9. [Medline].

  28. Blitzer A, Brin MF, Stewart C, Aviv JE, Fahn S. Abductor laryngeal dystonia: a series treated with botulinum toxin. Laryngoscope. Feb 1992;102(2):163-7. [Medline].

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Further Reading

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Keywords

spasmodic dysphonia, SD, focal dystonia, botulinum toxin, thyroplasty, spastic dysphonia, adductor dysphonia, abductor dysphonia, excessive glottic closure, regional dystonia, generalized dystonia, Meigs syndrome, blepharospasm, torticollis

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Contributor Information and Disclosures

Author

Michael J Pitman, MD, Assistant Professor, New York Medical College; Director, The Voice and Swallowing Institute; Director, Division of Laryngology, Department of Otolaryngology, New York Eye and Ear Infirmary
Michael J Pitman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, and Voice Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Ameet R Kamat, MD, Staff Physician, Department of Otolaryngology, New York Eye and Ear Infirmary
Ameet R Kamat, MD is a member of the following medical societies: Alpha Omega Alpha and Phi Beta Kappa
Disclosure: Nothing to disclose.

Darius Bliznikas, MD, Staff Physician, Department of Otolaryngology, Wayne State University School of Medicine
Darius Bliznikas, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

Soly Baredes, MD, Associate Professor of Clinical Surgery, Chief, Section of Otolaryngology-Head and Neck Surgery, Director, Division of Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Soly Baredes, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, American Society for Head and Neck Surgery, New York Academy of Medicine, New York Academy of Sciences, New York Head and Neck Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society
Disclosure: Nothing to disclose.

Medical Editor

Anthony P Sclafani, MD, Director of Facial Plastic Surgery, The New York Eye and Ear Infirmary; Professor of Otolaryngology, New York Medical College
Anthony P Sclafani, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American College of Surgeons
Disclosure: Medicis None Speaking and teaching; Contura None Board membership; Contura Grant/research funds Independent contractor; Cascade Medical Grant/research funds Independent contractor; Cascade Medical None Board membership

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Erik Kass, MD, Chief, Department of Clinical Otolaryngology, Associates in Otolaryngology of Northern Virginia
Erik Kass, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American Medical Association, and American Rhinologic Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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