Spasmodic Dysphonia

Spasmodic Dysphonia

1. Spasmodic Dysphonia Ade Wijaya, MD

2. Outline: Introduction Classification Anatomy Epidemiololy Risk Factors Pathophysiology Clinical Evaluation Differential Diagnosis Treatment Summary

3. Introduction Uncommon neurological disorder of the larynx that affects ∼1 in 100,000 individuals Chronic involuntary muscle contraction of the intrinsic laryngeal muscles, leading to action-specific disruptions in phonation The condition can involve the larynx alone, or it can be associated with a spectrum of head and neck dystonias such as blepharospasm , torticollis, hemifacial spasm, cervical dystonia, and Meige syndrome ( blepharospasm and oromandibular dystonia ) ≈ laryngeal dystonia Nutt JG, Muenter MD, Aronson A, et al. Epidemiology of focal and generalized dystonia in Rochester, Minnestoa. Mov Disord . 1988;3:188 – 194. Marsden CD, Sheehy MP. Spastic dysphonia, Meige disease and torsion dystonia . Neurology . 1982;32:1202 – 1203.

4. Classification M I X E D Blitzer A, Brin MF, Fahn S, et al. Clinical and laboratory characteristics of focal laryngeal dystonia: study of 110 cases. Laryngoscope . 1988;98:636 – 640

5. Anatomy Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87.

6. Epidemiology F:M = 2:1 4 th -6 th decade It may occur in patients with underlying neuromuscular disorders . Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87.

7. Risk Factors Genetic Environment Family history Autosomal dominant inheritance patterns in some cases Genes related to parkinsonism Psychologic factors Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87.

8. Pathophysiology Unclear Lesions of the brainstem and basal ganglia (?) 3 possible mechanism: Decreased inhibition of intracortical processes Increased plasticity leading to heightened response to repetitive activity - Sensory abnormalities resulting in disordered motor output Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87.

9. Clinical Evaluation Singing, whispering , and spontaneous emotional actions such as crying and laughing may be normal in patients with spasmodic dysphonia Patients can present with difficulty reading a new passage, and symptoms often worsen with stress 30 %  progressive Tanner K, Roy N, Merrill RM, et al. Spasmodic dysphonia: onset, course , socioemotional effects , and treatment response. Ann Otol Rhinol Laryngol . 2011;120:465 – 473 Braden MN, Hapner ER. Listening: the key to diagnosing spasmodic dysphonia . ORL Head Neck Nursing . 2008;26:8 – 12.

10. Adductor Spasmodic Dysphonia L ead to the vocal folds closing tightly , resulting in a strained or tight voice and cessation of airflow The spasms are best elicited when the vocal folds are approximating, for example , with vowels and voiced consonants such as /b/, /d/, /g/, and / m / Speech would sound strangled with premature breaks due to glottic closure Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87.

11. Abductor Spasmodic Dysphonia Spasm of the posterior cricoarytenoid muscle, the only abductor muscle of the larynx A breathy or whisper-like voice The involuntary opening of the vocal folds causes excessive airflow to escape and loss of vocalization . Patients have difficulty with /h/, /s/, /f/, /P/, /t/, and /k/. Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87.

12. Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87.

13. Differential Diagnosis Muscle tension dysphonia ( MTD) S trained or breathy voice that is consistently present throughout all vocal tasks. Essential tremor Parkinson Disease ( PD ) Spastic dysarthria Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87.

14. Treatment Botulinum toxin injection (adductor spasmodic dysphonia) Voice therapy Surgical treatment Chen DW, Ongkasuwan J. Spasmodic dysphonia. International ophthalmology clinics. 2018 Jan 1;58(1):77-87. French, G., Bosch, J.D. & Randall, D.R. Retrospective review of dosing trends in botulinum toxin injections for the treatment of adductor spasmodic dysphonia in a long-term cohort.  J of Otolaryngol - Head & Neck Surg   49,  4 (2020). https://doi.org/10.1186/s40463-020-0401-4

15. Summary Is a focal laryngeal dystonia Singing, whispering, and spontaneous emotional actions such as crying and laughing may be normal in patients with spasmodic dysphonia Botulinum injection

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