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11 - Botulinum toxin therapy of laryngeal muscle hyperactivity syndromes

Published online by Cambridge University Press:  28 July 2009

By
Daniel Truong ,
Arno Olthoff  and
Rainer Laskawi
Edited by
Daniel Truong ,
Dirk Dressler  and
Mark Hallett
Daniel Truong
Affiliation:
Orange Coast Memorial Medical Center
Dirk Dressler
Affiliation:
Hannover Medical School, Hannover, Germany
Mark Hallett
Affiliation:
George Washington University School of Medicine and Health Sciences, Washington, DC
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Summary

Introduction

Spasmodic dysphonia is a focal dystonia characterized by task-specific, action-induced spasm of the vocal cords. It adversely affects the patient's ability to communicate. It can occur independently, as part of cranial dystonia (Meige's syndrome), or in other disorders such as in tardive dyskinesia.

Clinical features

There are three types of spasmodic dysphonia: the adductor type, the abductor type, and the mixed type.

  • Adductor spasmodic dysphonia (ADSD) is characterized by a strained-strangled voice quality and intermittent voice stoppage or breaks due to overadduction of the vocal folds, resulting in a staccato-like voice.

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

  • Patients with the mixed type have presentations of both.

Symptoms of spasmodic dysphonia begin gradually over several months to years. The condition typically affects patients in their mid 40s and is more common in women (Adler et al., 1997; Schweinfurth et al., 2002).

Spasmodic dysphonia may coexist with vocal tremor. Patients with ADSD show evidence of phonatory breaks during vocalization. The vocal breaks typically occur during phonation associated with voiced speech sounds (Sapienza et al., 2000).

Stress commonly exacerbates speech symptoms; while they are absent during laughing, throat clearing, coughing, whispering, humming, and falsetto speech productions (Aronson et al., 1968). The voice tends to improve when the patient is emotional.

Treatment options for ADSD

The efficacy of botulinum toxin in the treatment of spasmodic dysphonia has been proven in a double-blind study (Truong et al., 1991).

Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 85 - 92
Publisher: Cambridge University Press
Print publication year: 2009

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References

Adler, C. H., Edwards, B. W. & Bansberg, S. F. (1997). Female predominance in spasmodic dysphonia. J Neurol Neurosurg Psychiatry, 63, 688.CrossRefGoogle ScholarPubMed
Adler, C. H., Bansberg, S. F., Hentz, J. G., et al. (2004a). Botulinum toxin type A for treating voice tremor. Archives of Neurology, 61, 1416–20.CrossRefGoogle ScholarPubMed
Adler, C. H., Bansberg, S. F., Krein-Jones, K. & Hentz, J. G. (2004b). Safety and efficacy of botulinum toxin type B (Myobloc) in adductor spasmodic dysphonia. Mov Disord, 19, 1075–9.CrossRefGoogle Scholar
Aronson, A. E., Brown, J. R., Litin, E. M. & Pearson, J. S. (1968). Spastic dysphonia. II. Comparison with essential (voice) tremor and other neurologic and psychogenic dysphonias. J Speech Hear Disord, 33, 219–31.CrossRefGoogle ScholarPubMed
Bielamowicz, S., Stager, S. V., Badillo, A. & Godlewski, A. (2002). Unilateral versus bilateral injections of botulinum toxin in patients with adductor spasmodic dysphonia. J Voice, 16, 117–23.CrossRefGoogle ScholarPubMed
Blitzer, A. & Sulica, L. (2001). Botulinum toxin: basic science and clinical uses in otolaryngology. Laryngoscope, 111, 218–26.CrossRefGoogle ScholarPubMed
Blitzer, A., Brin, M. F., Stewart, C., Aviv, J. E. & Fahn, S. (1992). Abductor laryngeal dystonia: a series treated with botulinum toxin. Laryngoscope, 102, 163–7.CrossRefGoogle ScholarPubMed
Brin, M. F., Fahn, S., Moskowitz, C., et al. (1988). Localized injections of botulinum toxin for the treatment of focal dystonia and hemifacial spasm. Adv Neurol, 50, 599–608.Google ScholarPubMed
Brin, M. F., Blitzer, A., Fahn, S., Gould, W. & Lovelace, R. E. (1989). Adductor laryngeal dystonia (spastic dysphonia): treatment with local injections of botulinum toxin (Botox). Mov Disord, 4, 287–96.CrossRefGoogle Scholar
Brin, M. F., Blitzer, A. & Stewart, C. (1998). Laryngeal dystonia (spasmodic dysphonia): observations of 901 patients and treatment with botulinum toxin. Adv Neurol, 78, 237–52.Google ScholarPubMed
Ford, C. N., Bless, D. M. & Lowery, J. D. (1990). Indirect laryngoscopic approach for injection of botulinum toxin in spasmodic dysphonia. Otolaryngol Head Neck Surg, 103, 752–8.CrossRefGoogle ScholarPubMed
Green, D. C., Berke, G. S., Ward, P. H. & Gerratt, B. R. (1992). Point-touch technique of botulinum toxin injection for the treatment of spasmodic dysphonia. Ann Otol Rhinol Laryngol, 101, 883–7.CrossRefGoogle ScholarPubMed
Guntinas-Lichius, O. (2003). Injection of botulinum toxin type B for the treatment of otolaryngology patients with secondary treatment failure of botulinum toxin type A. Laryngoscope, 113, 743–5.CrossRefGoogle ScholarPubMed
Klotz, D. A., Maronian, N. C., Waugh, P. F., et al. (2004). Findings of multiple muscle involvement in a study of 214 patients with laryngeal dystonia using fine-wire electromyography. Ann Otol Rhinol Laryngol, 113, 602–12.CrossRefGoogle Scholar
Koda, J. & Ludlow, C. L. (1992). An evaluation of laryngeal muscle activation in patients with voice tremor. Otolaryngol Head Neck Surg, 107, 684–96.CrossRefGoogle ScholarPubMed
Ludlow, C. L., Naunton, R. F., Sedory, S. E., Schulz, G. M. & Hallett, M. (1988). Effects of botulinum toxin injections on speech in adductor spasmodic dysphonia. Neurology, 38, 1220–5.CrossRefGoogle ScholarPubMed
Meleca, R. J., Hogikyan, N. D. & Bastian, R. W. (1997). A comparison of methods of botulinum toxin injection for abductory spasmodic dysphonia. Otolaryngol Head Neck Surg, 117, 487–92.CrossRefGoogle ScholarPubMed
Miller, R. H., Woodson, G. E. & Jankovic, J. (1987). Botulinum toxin injection of the vocal fold for spasmodic dysphonia. A preliminary report. Arch Otolaryngol Head Neck Surg, 113, 603–5.CrossRefGoogle ScholarPubMed
Rhew, K., Fiedler, D. A. & Ludlow, C. L. (1994). Technique for injection of botulinum toxin through the flexible nasolaryngoscope. Otolaryngol Head Neck Surg, 111, 787–94.CrossRefGoogle ScholarPubMed
Sapienza, C. M., Walton, S. & Murry, T. (2000). Adductor spasmodic dysphonia and muscular tension dysphonia: acoustic analysis of sustained phonation and reading. J Voice, 14, 502–20.CrossRefGoogle Scholar
Schweinfurth, J. M., Billante, M. & Courey, M. S. (2002). Risk factors and demographics in patients with spasmodic dysphonia. Laryngoscope, 112, 220–3.CrossRefGoogle ScholarPubMed
Schönweiler, R., Wohlfarth, K., Dengler, R. & Ptok, M. (1998). Supraglottal injection of botulinum toxin type A in adductor type spasmodic dysphonia with both intrinsic and extrinsic hyperfunction. Laryngoscope, 108, 55–63.CrossRefGoogle ScholarPubMed
Truong, D. & Bhidayasiri, R. (2006). Botulinum toxin in laryngeal dystonia. Eur J Neurol, 13(Suppl 1), 36–41.CrossRefGoogle Scholar
Truong, D. D., Rontal, M., Rolnick, M., Aronson, A. E. & Mistura, K. (1991). Double-blind controlled study of botulinum toxin in adductor spasmodic dysphonia. Laryngoscope, 101, 630–4.CrossRefGoogle Scholar
Zwirner, P., Dressler, D. & Kruse, E. (1997). Spasmodic laryngeal dyspnea: a rare manifestation of laryngeal dystonia. Eur Arch Otorhinolaryngol, 254, 242–5.CrossRefGoogle ScholarPubMed

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