Abductor paralysis after botox injection for adductor spasmodic dysphonia

Intralaryngeal injections of botulinum toxin (Botox), under electromyographic guidance, have emerged as an effective treatment for adductor spasmodic dysphonia. To remain effective, these injections must be repeated every 3 to 9 months as the symptoms recur. One drawback to the current method is the need for electromyographic confirmation of needle placement into the thyroarytenoid muscle. This report describes an anatomic approach to Botox injection that requires only flexible nasopharyngeal endoscopy and careful evaluation of the anatomic landmarks. This technique has been used successfully on 13 patients, and objective pretreatment and posttreatment measures are reported.

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Employer Reactions to Adductor Spasmodic Dysphonia: Exploring the Influence of Symptom Severity and Disclosure of Diagnosis During a Simulated Telephone Interview

American Journal of Speech-Language Pathology ◽

10.1044/2016_ajslp-16-0040 ◽

2017 ◽

Vol 26 (2) ◽

pp. 469-482 ◽

Cited By ~ 1

Author(s):

Derek D. Isetti ◽

Carolyn R. Baylor ◽

Michael I. Burns ◽

Tanya L. Eadie

Keyword(s):

Symptom Severity ◽

Structured Interview ◽

Voice Disorder ◽

Spasmodic Dysphonia ◽

Severe Condition ◽

Phone Interview ◽

Interview Process ◽

Adductor Spasmodic Dysphonia ◽

Disclosure Of Diagnosis ◽

Botox Injection

PurposeThe purpose of this study was to determine the influence of symptom severity and disclosure of adductor spasmodic dysphonia (ADSD) on the perceptions of human resource personnel members (HRPs) during a simulated phone interview.MethodOne female speaker with ADSD was recorded reading an interview script at two time points: (a) pre-BOTOX injection (severe), and (b) post-BOTOX injection (mild). Thirty-two HRPs evaluated the recording in one of the two conditions via a qualitative structured interview. HRPs gave their recommendations regarding when and how to disclose ADSD.ResultsIn the mild condition, no HRP perceived that the applicant had a voice disorder. Disclosure was not recommended as often, as an impairment was not initially noticed. However, 15/16 HRPs commented on the applicant's voice in the severe condition, with most suspecting she was a smoker or had lung/throat cancer. Disclosure in the severe condition was recommended more often, as it clarified symptoms that were noted at the outset.ConclusionsSymptom severity in ADSD influences employer perceptions during the phone interview process. Incorrect assumptions may be made about applicants with severe symptoms, and apparentness of symptoms influences whether or not disclosure is recommended. Results have implications for counseling individuals with ADSD who are navigating the job interview process.

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Speech Intelligibility in Severe Adductor Spasmodic Dysphonia

Journal of Speech Language and Hearing Research ◽

10.1044/1092-4388(2004/003) ◽

2004 ◽

Vol 47 (1) ◽

pp. 21-32 ◽

Cited By ~ 11

Author(s):

Brenda K. Bender ◽

Michael P. Cannito ◽

Thomas Murry ◽

Gayle E. Woodson

Keyword(s):

Botulinum Toxin ◽

Normal Control ◽

Speech Intelligibility ◽

Spasmodic Dysphonia ◽

Age And Gender ◽

Adductor Spasmodic Dysphonia ◽

Before And After ◽

And Gender ◽

Listening Experiment ◽

Botox Injection

This study compared speech intelligibility in nondisabled speakers and speakers with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (Botox) injection. Standard speech samples were obtained from 10 speakers diagnosed with severe ADSD prior to and 1 month following Botox injection, as well as from 10 age- and gender-matched healthy adults. This yielded 3 speaking conditions: pre-Botox injection, post-Botox injection, and normal control. Thirty phrases were extracted from the speech samples and arranged in a counterbalanced listening experiment. Thirty students, reporting little experience with distorted speech, served as listeners. Each listener's response was scored for words correctly identified using a liberal scoring criterion yielding a percentage of words correctly identified for each speaker. The results indicated that the speakers with ADSD were significantly more intelligible in the post-Botox condition than in the pre-Botox condition. The results also indicated that healthy speakers were significantly more intelligible than the speakers in both the preand post-Botox conditions. In general, these results indicated that intelligibility is affected in severe ADSD and that the use of Botox injection in ADSD improves intelligibility scores. However, the results also indicated that the use of Botox injection does not result in speech intelligibility similar to that of normal, non-ADSD speakers.

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Charateristics of Oral and Laryngeal Diadochokinesis in Adductor Spasmodic Dysphonia Speakers

Journal of speech-language & hearing disorders ◽

10.15724/jslhd.2014.23.3.003 ◽

2014 ◽

Vol 23 (3) ◽

pp. 27-34

Author(s):

박희준 ◽

배인호 ◽

Soon-Bok Kwon ◽

Geun-Hyo Kim

Keyword(s):

Spasmodic Dysphonia ◽

Adductor Spasmodic Dysphonia ◽

Laryngeal Diadochokinesis

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Surgical Treatment of Adductor Spasmodic Dysphonia in a Patient with Gender Identity Disorder

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.60.489 ◽

2009 ◽

Vol 60 (6) ◽

pp. 489-495

Author(s):

Kazuhiro Nakamura ◽

Yusuke Watanabe ◽

Kiyoaki Tsukahara ◽

Ujimoto Konomi ◽

Daigo Komazawa ◽

...

Keyword(s):

Surgical Treatment ◽

Gender Identity ◽

Gender Identity Disorder ◽

Spasmodic Dysphonia ◽

Adductor Spasmodic Dysphonia

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Treatment of Adductor Spasmodic Dysphonia by Type 2 Thyroplasty Using Titanium Bridges

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.67.85 ◽

2016 ◽

Vol 67 (2) ◽

pp. 85-85

Author(s):

T. Sanuki ◽

E. Yumoto ◽

K. Mizoguchi ◽

N. Oridate ◽

T. Nito ◽

...

Keyword(s):

Spasmodic Dysphonia ◽

Adductor Spasmodic Dysphonia

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Cross-Innervation of the Thyroarytenoid Muscle by a Branch from the External Division of the Superior Laryngeal Nerve

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600712 ◽

1997 ◽

Vol 106 (7) ◽

pp. 594-598 ◽

Cited By ~ 41

Author(s):

Sina Nasri ◽

Joel A. Sercarz ◽

Pouneh Beizai ◽

Young-Mo Kim ◽

Ming Ye ◽

...

Keyword(s):

Vocal Fold ◽

Superior Laryngeal Nerve ◽

Laryngeal Nerve ◽

Spasmodic Dysphonia ◽

Clinical Implications ◽

Motor Innervation ◽

Vocal Fold Vibration ◽

Adductor Spasmodic Dysphonia ◽

Thyroarytenoid Muscle ◽

Stimulation Of

The neuroanatomy of the larynx was explored in seven dogs to assess whether there is motor innervation to the thyroarytenoid (TA) muscle from the external division of the superior laryngeal nerve (ExSLN). In 3 animals, such innervation was identified. Electrical stimulation of microelectrodes applied to the ExSLN resulted in contraction of the TA muscle, indicating that this nerve is motor in function. This was confirmed by electromyographic recordings from the TA muscle. Videolaryngostroboscopy revealed improvement in vocal fold vibration following stimulation of the ExSLN compared to without it. Previously, the TA muscle was thought to be innervated solely by the recurrent laryngeal nerve. This additional pathway from the ExSLN to the TA muscle may have important clinical implications in the treatment of neurologic laryngeal disorders such as adductor spasmodic dysphonia.

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Laryngeal Framework Surgery in the Management of Spasmodic Dysphonia

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909800111 ◽

1989 ◽

Vol 98 (1) ◽

pp. 52-54 ◽

Cited By ~ 34

Author(s):

Harvey M. Tucker

Keyword(s):

Vocal Fold ◽

Vocal Folds ◽

Long Term Results ◽

Spasmodic Dysphonia ◽

Management Problem ◽

Cure Rate ◽

Adductor Spasmodic Dysphonia ◽

Laryngeal Framework Surgery ◽

Selective Lysis

Spasmodic dysphonia continues to be a management problem for otolaryngologists. Selective lysis of the recurrent laryngeal nerve has been useful in the management of this disease. Reported long-term results, however, reveal that spasm recurs in approximately 40% to 50% of initially successful patients in spite of persistence of the unilateral vocal fold paralysis. Although some of these failures can be recaptured with subsequent laser surgery, the overall “cure” rate does not exceed 70%, even in the best hands. The contributions of Isshiki, LeJeune, and Tucker have demonstrated that tension in the vocal folds can be adjusted by laryngeal framework surgery. Experience with 16 patients suffering from adductor spasmodic dysphonia suggests that laryngeal framework surgery is useful in the management of this disorder.

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