eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Laryngology

Spasmodic Dysphonia: Follow-up

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

Outcome and Prognosis

Most patients experience toxin effect within the first 48-72 hours after injection, with a variable amount of breathy dysphonia and slight aspiration. These adverse effects disappear within the first week, but voice improvement persists for approximately 12 weeks.

Treatment of adductor spasmodic dysphonia (SD) with botulinum toxin achieves good results, with an average benefit of 90% of normal voice function.6

Treatment of abductor spasmodic dysphonia (SD) is more difficult. The abductor muscle (the PCA) is located between the larynx and pharynx and is more difficult to inject. Most patients require bilateral PCA injections. Botulinum toxin treatment achieves an average benefit of 70% of normal voice function.28

Future and Controversies

Surgical therapy for spasmodic dysphonia (SD) is still controversial because the side effects can be severe, and wide evaluation with long-term follow-up data is not available.

To date, botulinum toxin injection is the standard therapy for spasmodic dysphonia (SD). Unfortunately, this is just a treatment at the end organ and is not a cure. The key to understanding this disorder is to understand its pathophysiology and that of other spasmodic movement disorders.

Current research, especially gene research, is progressing in the elucidation of the cause of focal dystonia. Advances in the understanding of genetically determined early-onset primary torsion dystonia are offering insight into the pathophysiology of dystonia. An amino acid deletion in the DYT1 gene has been found to be responsible for familial primary torsion dystonia. This defect results in an abnormality in the protein torsinA, which is widely distributed in the CNS.29 Further investigation of the of this gene and its protein products will hopefully spur advances in our understanding of dystonia and improve our treatment of the disorder.

 


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].

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  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].

  8. Koufman JA, Rees CJ, Halum SL, Blalock D. Treatment of adductor-type spasmodic dysphonia by surgical myectomy: a preliminary report. Ann Otol Rhinol Laryngol. Feb 2006;115(2):97-102. [Medline].

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  10. Blitzer A, Brin MF, Stewart CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope. Oct 1998;108(10):1435-41. [Medline].

  11. Kramer PL, de Leon D, Ozelius L, et al. Dystonia gene in Ashkenazi Jewish population is located on chromosome 9q32-34. Ann Neurol. Feb 1990;27(2):114-20. [Medline].

  12. Zweig RM, Hedreen JC, Jankel WR, Casanova MF, Whitehouse PJ, Price DL. Pathology in brainstem regions of individuals with primary dystonia. Neurology. May 1988;38(5):702-6. [Medline].

  13. Simonyan K, Tovar-Moll F, Ostuni J, et al. Focal white matter changes in spasmodic dysphonia: a combined diffusion tensor imaging and neuropathological study. Brain. Feb 2008;131:447-59. [Medline].

  14. Ali SO, Thomassen M, Schulz GM, et al. Alterations in CNS activity induced by botulinum toxin treatment in spasmodic dysphonia: an H215O PET study. J Speech Lang Hear Res. Oct 2006;49(5):1127-46. [Medline].

  15. Hillel AD. The study of laryngeal muscle activity in normal human subjects and in patients with laryngeal dystonia using multiple fine-wire electromyography. Laryngoscope. Apr 2001;111(4 Pt 2 Suppl 97):1-47. [Medline].

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  20. Bielamowicz S, Squire S, Bidus K, Ludlow CL. Assessment of posterior cricoarytenoid botulinum toxin injections in patients with abductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. May 2001;110(5 Pt 1):406-12. [Medline].

  21. Stong BC, DelGaudio JM, Hapner ER, Johns MM 3rd. Safety of simultaneous bilateral botulinum toxin injections for abductor spasmodic dysphonia. Arch Otolaryngol Head Neck Surg. Sep 2005;131(9):793-5. [Medline].

  22. Holden PK, Vokes DE, Taylor MB, Till JA, Crumley RL. Long-term botulinum toxin dose consistency for treatment of adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. Dec 2007;116(12):891-6. [Medline].

  23. Hillel AD, Maronian NC, Waugh PF, Robinson L, Klotz DA. Treatment of the interarytenoid muscle with botulinum toxin for laryngeal dystonia. Ann Otol Rhinol Laryngol. May 2004;113(5):341-8. [Medline].

  24. Ludlow CL, Naunton RF, Terada S, Anderson BJ. Successful treatment of selected cases of abductor spasmodic dysphonia using botulinum toxin injection. Otolaryngol Head Neck Surg. Jun 1991;104(6):849-55. [Medline].

  25. Chan SW, Baxter M, Oates J, Yorston A. Long-term results of type II thyroplasty for adductor spasmodic dysphonia. Laryngoscope. Sep 2004;114(9):1604-8. [Medline].

  26. Berke GS, Blackwell KE, Gerratt BR, Verneil A, Jackson KS, Sercarz JA. Selective laryngeal adductor denervation-reinnervation: a new surgical treatment for adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. Mar 1999;108(3):227-31. [Medline].

  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].

  29. Ozelius LJ, Hewett JW, Page CE, et al. The early-onset torsion dystonia gene (DYT1) encodes an ATP-binding protein. Nat Genet. Sep 1997;17(1):40-8. [Medline].

  30. Sulica L. Contemporary management of spasmodic dysphonia. Curr Opin Otolaryngol Head Neck Surg. Dec 2004;12(6):543-8. [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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