Respiratory distress after recurrent laryngeal nerve sectioning for adductor spastic dysphonia

Adductor spastic dysphonia is a voice sign associated with various neurologic and psychologic disorders. Treatment of spastic dysphonia in selected patients is unilateral recurrent laryngeal nerve sectioning. Except for voice change or, in some patients, return of phonatory spasticity, there have been no long-term sequelae or complications of this treatment. We describe three patients with adductor spastic dysphonia who underwent recurrent laryngeal nerve sectioning and who, 3 to 38 months later, suffered respiratory distress that required tracheostomy. The respiratory distress in all three patients was due to episodic jerky vocal cord hyperadductions that caused stridor during inspiration and expiration. These repetitive laryngospasms during respiration and phonation were progressive. Two patients needed an arytenoidectomy to achieve a useful voice, and all three required a permanent tracheostomy to alleviate inspiratory laryngeal obstruction.