ENT and Allergy Magazine Volume I, Issue VIII - ENT & Allergy ...

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e n t a n d a l l e r g y . c o m
this ailment, there are no laboratory studies to confirm its
diagnosis. Radiographic studies are used only to evaluate other
causes of dystonia not indicative of Spasmodic Dysphonia. On
physical examination, it is important to rule out other dystonias,
tremors, or neurological signs. However, perceptual analysis
of the voice is generally considered the most specific method
of diagnosis. Because SD is a task specific dystonia, certain
sentences have been found helpful in eliciting the specific voice
breaks. These include:
“We mow our lawn all year.”
“The dog dug a new bone.”
“How high is Harry’s hat”
Other evaluations include aerodynamic and acoustic measurements
performed by a Speech Language Pathologist.
Although not diagnostic, some of the findings such as airflow
and subglottic pressure are characteristic of each subtype of SD.
The accepted treatment for Spasmodic Dysphonia today is
Botulinum toxin therapy (Botox). Because there is no cure for
Spasmodic Dysphonia, Botox injections into the vocal cord offer
an excellent treatment option. The therapy involves injecting
small doses of the toxin into the vocal cord muscles causing a
chemical denervation by blocking the release of acetylcholine
at the neuromuscular junction. The procedure is performed in
the office under EMG guidance to confirm accurate placement
of the toxin into the desired muscle. Most patients will see
the desired effect of the treatment begin at 48 - 72 hours after
the injection, with the therapeutic benefit lasting on average,
3 months. For the Adductor type of SD, the thyroarytenoid
muscles are injected bilaterally. In essence, the vocal cords are
partially and temporarily “paralyzed” in the open position.
This may yield a breathy voice for up to 1-2 weeks, with the
voice ultimately smoothing out. As the Botox effect wears off,
the typical SD symptoms will return. Patients are advised to be
careful with swallowing, especially when breathy, to decrease the
chance of aspiration.
Spasmodic Dysphonia is a cryptic neurologic voice disorder.
It is uncommon, but not as rare as once thought. More than
likely, nearly any physician can diagnose this, once their trained
ear knows what to listen for. Unfortunately, there is no cure
for this SD. However, EMG guided Botox injections provide
an excellent source of symptom relief which is temporary, but
comfortably repeatable.
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