Adductor laryngeal dystonia (spastic dysphonia): Treatment with local injections of botulinum toxin (Botox)

Mitchell F. Brin, Andrew Blitzer, Stanley Fahn, Robert E. Lovelace, Wilbur Gould

Research output: Contribution to journalArticlepeer-review

85 Scopus citations

Abstract

Adductor spastic dysphonia (SD) is a laryngeal dystonia characterized by a choked, constrained voice pattern with breaks in vocal flow. Treatment with a variety of therapies including speech and pharmacotherapy have minimal benefit; only one‐third of patients undergoing recurrent laryngeal nerve section have benefitted at 3 years. We have used local injections of botulinum toxin (Botox) bilaterally into vocalis muscles in 42 patients with SD. Injections were through a teflon‐coated hollow electromyography (EMG) recording needle. Unilateral small doses (2.53.75 U) were of no clinical benefit. Bilateral small doses resulted in sustained improvement lasting 84.4 ± 9.3 days. The degree of improvement was 61.1 ± 4.6%. Common side‐effects included a brief period of breathy hypophonia (8.5 ± 2.5 days) and a mild sensation of choking/aspiration of fluids (1.7 ± 0.6 days); there were no serious adverse effect. Vocal cord paralysis was not necessary for benefit. Follow‐up vocalis muscle EMGs revealed denervation. All patients responded to retreatment (longest follow‐up 3.5 years). Patients with prior recurrent laryngeal nerve surgery and residual uncomplicated dysphonia had similar results. Our results indicate that local injection of low‐dose Botox is the treatment of choice for SD.

Original languageEnglish
Pages (from-to)287-296
Number of pages10
JournalMovement Disorders
Volume4
Issue number4
DOIs
StatePublished - 1989
Externally publishedYes

Keywords

  • Abductor
  • Adductor
  • Botox
  • Botulinum toxin
  • Breathy hypophonia
  • Dystonia
  • Laryngeal dystonia
  • Spastic dysphonia
  • Vocalis muscles

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