Spasmodic dysphonia combined with insufficient glottic closure by phonation

Area of Science:

• Otolaryngology
• Neurology
• Speech Pathology

Background:

• Vocal cord dysfunction can arise from multiple etiologies, including hyperkinetic movement disorders and structural abnormalities.
• Spasmodic dysphonia (SD) presents with involuntary vocal cord spasms, leading to strained or breathy voice quality.
• Vocal fold atrophy can cause incomplete glottic closure, resulting in a weak or breathy voice.

Observation:

• A patient presented with a complex voice disorder characterized by spasmodic dysphonia-like symptoms and vocal weakness due to vocal cord atrophy.
• The patient exhibited hyperkinetic movement affecting vocal cord adduction and insufficient glottic closure in the mid-membranous portion.
• This dual pathology resulted in a pressed, interrupted, and powerless voice.

Findings:

• A two-step therapeutic approach was employed, beginning with transcutaneous electromyography (EMG)-guided injection of 25 IU of Botulinum toxin type A (Botox) into the left vocal cord.
• Following Botox injection, the patient achieved a fluent but breathy voice, indicating partial improvement.
• Subsequent lipoaugmentation of the left vocal cord was performed under high-frequency jet anesthesia to address the glottic insufficiency, resulting in a fluent and clear voice.

Implications:

• This case highlights the potential efficacy of a combined therapeutic strategy for managing complex voice disorders involving both hyperkinetic movement and structural deficits.
• The findings suggest that Botox injections can temporarily alleviate spasmodic dysphonia symptoms, while lipoaugmentation may offer a more durable solution for glottic insufficiency.
• Further research is warranted to optimize treatment protocols and long-term management of such combined vocal pathologies, including the need for repeated Botox interventions.