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Spasmodic dysphonia: botulinum toxin injection after recurrent nerve surgery.

C L Ludlow1, R F Naunton, M Fujita

  • 1Speech and Voice Unit, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD 20892.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|February 1, 1990
PubMed
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Botulinum toxin injections effectively treated adductor spasmodic dysphonia recurrence after surgery. This approach reduced thyroarytenoid muscle activation and improved speech symptoms in patients with persistent vocal fold paralysis.

Area of Science:

  • Otolaryngology
  • Neurology
  • Speech-Language Pathology

Background:

  • Adductor spasmodic dysphonia (AdSD) can recur after recurrent laryngeal nerve surgery.
  • Symptom recurrence is linked to thyroarytenoid muscle reinnervation.
  • Patients may experience persistent unilateral vocal fold paralysis and speech difficulties.

Purpose of the Study:

  • To evaluate the efficacy of botulinum toxin injections in treating recurrent AdSD symptoms post-surgery.
  • To assess the impact of injections on thyroarytenoid muscle activity and speech parameters.

Main Methods:

  • Five patients with recurrent AdSD after surgery received Type A botulinum toxin injections.
  • Injections targeted the thyroarytenoid muscle, sometimes bilaterally.
  • Spectrographic and electromyographic measures assessed vocal symptoms and muscle activation pre- and post-injection.

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Main Results:

  • Significant reductions in AdSD speech symptoms (pitch, voice breaks, aperiodicity) were observed post-injection (p ≤ 0.002).
  • Electromyography showed significant decreases in thyroarytenoid muscle activation on both injected and non-injected sides (p ≤ 0.01).
  • Pre-injection assessments confirmed heightened muscle activity and significant dysphonia symptoms.

Conclusions:

  • Botulinum toxin injections are an effective treatment for recurrent adductor spasmodic dysphonia following surgery.
  • The treatment successfully reduced aberrant muscle activity and ameliorated speech symptoms.
  • This intervention offers a viable option for managing post-surgical symptom recurrence in AdSD.