Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Spasmodic Dysphonia Workup

  • Author: Michael J Pitman, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: May 01, 2015
 

Laboratory Studies

Laboratory tests are generally unnecessary.

Next

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).

Previous
Next

Other Tests

A study by Creighton et al indicated that the diagnosis of spasmodic dysphonia can be delayed by years owing to a lack of physician awareness of the condition and the need for well-defined diagnostic criteria. The study, in which 107 patients with spasmodic dysphonia answered questionnaires concerning diagnosis and treatment, found that diagnosis of the condition took an average of 4.43 years after patients first saw a physician for vocal symptoms. Patients also required visits to an average of 3.95 physicians before receiving the correct diagnosis.[16]

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.[17]

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.[18]

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.

Previous
Next

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.

Previous
 
 
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, Voice Foundation, American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Soly Baredes, MD Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School; Director of Otolaryngology-Head and Neck Surgery, University Hospital

Soly Baredes, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Laryngological Association, The Triological Society, American Medical Association, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society, New York Head and Neck Society, New York Laryngological Society, New Jersey Academy of Otolaryngology-Head and Neck Surgery, The New Jersey Academy of Facial Plastic Surgery, International Skull Base Society

Disclosure: Nothing to disclose.

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Medical Association, American Association for Cancer Research, American Rhinologic Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Anthony P Sclafani, MD Director of Facial Plastic Surgery and Surgeon Director, New York Eye and Ear Infirmary of Mt Sinai; Professor of Otolaryngology, Icahn School of Medicine at Mt Sinai

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, American College of Surgeons

Disclosure: Received salary from Aesthetic Factors, Inc. for consulting; Received consulting fee from Meditech Medical Enterprises for independent contractor; Received royalty from Thieme Medical Publishers for author; Received royalty from Jaypee Medical Publishers for author.

Acknowledgements

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.

References
  1. Traube L. Spastishe form der nervosen helserkeit. Gesammelte beltrage zur pathologie und physiologie. 1871. 2:677.

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

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

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

  5. Isshiki N, Haji T, Yamamoto Y, Mahieu HF. Thyroplasty for adductor spasmodic dysphonia: further experiences. Laryngoscope. 2001 Apr. 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. 1988 Feb. 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. 2006 Apr. 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. 2006 Feb. 115(2):97-102. [Medline].

  9. Schweinfurth JM, Billante M, Courey MS. Risk factors and demographics in patients with spasmodic dysphonia. Laryngoscope. 2002 Feb. 112(2):220-3. [Medline].

  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. 1998 Oct. 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. 1990 Feb. 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. 1988 May. 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. 2008 Feb. 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. 2006 Oct. 49(5):1127-46. [Medline].

  15. Childs L, Rickert S, Murry T, Blitzer A, Sulica L. Patient perceptions of factors leading to spasmodic dysphonia: A combined clinical experience of 350 patients. Laryngoscope. 2011 Jul 20. [Medline].

  16. Creighton FX, Hapner E, Klein A, et al. Diagnostic Delays in Spasmodic Dysphonia: A Call for Clinician Education. J Voice. 2015 Apr 11. [Medline].

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

  18. Fulmer S, Merati A, Blumin J. Efficacy of laryngeal botulinum toxin injection: Comparison of two techniques. Laryngoscope. 2011 Sep. 121(9):1924-8.

  19. Sanuki T, Isshiki N. Overall evaluation of effectiveness of type II thyroplasty for adductor spasmodic dysphonia. Laryngoscope. 2007 Dec. 117(12):2255-9. [Medline].

  20. Murry T, Woodson GE. Combined-modality treatment of adductor spasmodic dysphonia with botulinum toxin and voice therapy. J Voice. 1995 Dec. 9(4):460-5. [Medline].

  21. Hallett M. How does botulinum toxin work?. Ann Neurol. 2000 Jul. 48(1):7-8. [Medline].

  22. Thomas JP, Siupsinskiene N. Frozen versus fresh reconstituted botox for laryngeal dystonia. Otolaryngol Head Neck Surg. 2006 Aug. 135(2):204-8. [Medline].

  23. 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. 2001 May. 110(5 Pt 1):406-12. [Medline].

  24. 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. 2005 Sep. 131(9):793-5. [Medline].

  25. 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. 2007 Dec. 116(12):891-6. [Medline].

  26. 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. 2004 May. 113(5):341-8. [Medline].

  27. 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. 1991 Jun. 104(6):849-55. [Medline].

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

  29. Nomoto M, Tokashiki R, Hiramatsu H, et al. The Comparison of Thyroarytenoid Muscle Myectomy and Type II Thyroplasty for Spasmodic Dysphonia. J Voice. 2015 Feb 27. [Medline].

  30. 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. 1999 Mar. 108(3):227-31. [Medline].

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

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

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

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

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.