Spasmodic Dysphonia Workup

  • Author: Michael J Pitman, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Sep 23, 2011
 

Laboratory Studies

Laboratory tests are generally unnecessary.

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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).

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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.[16]

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). In experienced hands, EMG guidance may not be necessary.[17]

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.

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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.

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Contributor Information and Disclosures
Author

Michael J Pitman, MD  Assistant Professor of Otolaryngology, New York Medical College; Director, Division of Laryngology, Director, The Voice and Swallowing Institute, Department of Otolaryngology, The 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.

Specialty Editor Board

Anthony P Sclafani, MD  Director of Facial Plastic Surgery and Surgeon Director, 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: Contura None Board membership; Aesthetic Factors, Inc. Grant/research funds Independent contractor

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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Thyroarytenoid injection for adductor spasmodic dysphonia. Needle is advanced through the cricothyroid membrane.
Posterior cricoarytenoid (PCA) injection for abductor spasmodic dysphonia. Needle is advanced through the inferior constrictor muscle to the PCA muscle.
 
 
 
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