Spasmodic Dysphonia and Vocal Tremor

Abstract The Laryngeal Movement Disorder Clinic (LMDC) was started in 1990 in the Department of Otolaryngology at the University of Iowa. This specialized subset of the general Voice Clinic ( http://www.healthcare.uiowa.edu/otolaryngology/protocols/Parts/Part1/Part1C/P1C1.htm ) is scheduled twice a month for patients with laryngeal movement disorders such as spasmodic dysphonia (SD), vocal tremor, muscle tension dysphonia (MTD), and vocal fold paralysis (VCP). Patients with other craniocervical dystonias also may be seen in this clinic. The purpose of the clinic is to provide specialized diagnostic assessments and treatments. Application of electromyography for diagnosis as well as for directed botulinum toxin injections dominates the practice of this clinic. Voice therapy also is directed through this clinic, with coordination through practitioners in the University of Iowa system or, more commonly, with practitioners who are located closer to the patients' homes. It is the purpose of this article to describe the clinical pathways for patients who are seen at the LMDC from a multidisciplinary perspective. This summary will include aspects of differential diagnosis and clinical history taking, assessment, and treatment for those with laryngeal movement disorders.

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Neurogenic Laryngeal Disorders

10.2310/ot.7068 ◽

2021 ◽

Author(s):

Yin Yiu ◽

Teresa Procter

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin Injection ◽

Muscle Tension ◽

Voice Disorders ◽

Spasmodic Dysphonia ◽

Swallowing Function ◽

Laryngeal Dystonia ◽

Adductor Spasmodic Dysphonia ◽

Neurologic Disorders ◽

Vocal Tremor

The larynx is critical to performing complex tasks of airway protection, phonation, respiration, and deglutition. Various focal and systemic neurologic disorders impact the larynx, causing deficits that lead to dysfunction in voice, speech, breathing, and swallowing function. The most common hyperfunctional neurolaryngeal disorders include spasmodic dysphonia (laryngeal dystonia), essential vocal tremor, and muscle tension dysphonia. Some hypofunctional neurolaryngeal disorders include parkinsonian disorders, neuromuscular junction diseases, and myopathies. A multidisciplinary approach involving evaluation by neurologists, voice-trained otolaryngologists and speech-language pathologists is often key to diagnosis and treatment of these challenging and sometimes lifelong disorders. Botulinum toxin injection into the laryngeal musculature is currently the gold-standard treatment for both spasmodic dysphonia and vocal tremor. However, much research is being conducted to advance less invasive and more definitive medical and surgical treatment interventions. This review contains 3 figures, 11 videos, 6 tables and 29 references Keywords: laryngeal neurophysiology, laryngeal dystonia, adductor spasmodic dysphonia, abductor spasmodic dysphonia, essential vocal tremor, hyperfunctional voice disorders, hypofunctional voice disorders, botulinum toxin injection

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