Surgery or botulinum toxin for adductor spasmodic dysphonia: a comparative study

Area of Science:

• Otolaryngology
• Neurology
• Speech-Language Pathology

Background:

• Adductor spasmodic dysphonia (ADSD) is a voice disorder typically managed with botulinum toxin (Botox) injections.
• The efficacy and long-term outcomes of surgical interventions for ADSD compared to standard treatments require further investigation.

Purpose of the Study:

• To compare the effectiveness of selective laryngeal adductor denervation-reinnervation (SLAD-R) surgery against Botox injections for treating ADSD.
• To evaluate patient-oriented and objective voice outcome measures for both treatment modalities.

Main Methods:

• A retrospective study of 77 patients undergoing SLAD-R surgery (mean follow-up: 7.54 years) and a prospective study of 28 patients receiving Botox injections (mean follow-up: 46.37 days).
• Outcome measures included the Voice Handicap Index-10 (VHI-10) and objective grading of digital voice recordings.

Main Results:

• SLAD-R surgery resulted in significantly lower VHI-10 scores (14.4) compared to Botox injections (26.5; p=0.001), indicating a superior voice handicap outcome.
• The surgical group showed significant improvements in most VHI-10 components, with 82% recommending surgery and 78% reporting better voice post-surgery.
• While 88% of Botox patients found it effective, only 63% reported consistent speech improvement. Objective voice quality and breathiness were similar between groups.

Conclusions:

• Selective laryngeal adductor denervation-reinnervation (SLAD-R) surgery provides outcomes that are equal to or better than Botox injections for appropriately selected ADSD patients.
• SLAD-R surgery offers a potentially more durable and effective long-term solution for managing adductor spasmodic dysphonia.