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Plans for Spasmodic Dysphonia Page

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One area I definitely want to work on is the treatment section. There are recent reviews and meta-analysis([1],[2],[3]) I have found in my preliminary search for information that may provide new information.

Kengjalrnvjwngj (talk) 01:11, 30 September 2017 (UTC)

I think it may be a good idea to add audio samples. Kengjalrnvjwngj (talk) 14:57, 16 October 2017 (UTC)

Draft lead section for Spasmodic Dysphonia

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Spasmodic dysphonia, also known as laryngeal dystonia, is a disorder in which the muscles that generate a person's voice go into periods of spasm.[4][5] This results in breaks or interruptions in the voice which can make a person difficult to understand.[4] The person's voice may also sound strained or they may be nearly unable to speak.[5] Often onset is gradual and the condition is life long.[4]

The cause is unknown.[4] Risk factors may include family history of neurological disorders.[4],[6] Triggers may include an upper respiratory infection, injury to the larynx, overuse of the voice, and psychological stress.[4] The underlying mechanism is believed to typically involve the central nervous system, specifically the basal ganglia.[4] Diagnosis is typically made following examination by a team of healthcare providers.[4]


While there is no cure, treatment may improve symptoms.[4] Most commonly this involves injecting botulinum toxin into the affected muscles of the larynx.[4] This generally results in improvement for a few months.[4] Other measures include voice therapy, counselling, and amplification devices.[4] Rarely surgery may be considered.[4]

The disorder affects an estimated 1 per 100,000 people.[7] Women are more commonly affected.[4] Average age of onset is 45 years old.[8], [9] Severity is variable between people.[5] In some work and social life are affected.[5] Life expectancy is, however, normal.[10]

Kengjalrnvjwngj (talk) 00:27, 8 October 2017 (UTC)

Draft of contribution to Treatment section for Spasmodic Dysphonia

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Treatment

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There are a number of potential treatments for spasmodic dysphonia, including botox, surgery and voice therapy.[11] A number of medications have also been tried including anticholinergics (such as benztropine) which have been found to be effective in 40-50% of people, but which are associated with a number of side effects.[12]

Voice therapy

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Voice therapy appears to be ineffective in cases of true spasmodic dysphonia,[13] however as it is difficult to distinguish between spasmodic dysphonia and functional dysphonias and misdiagnosis is relatively common,[14] a trial of voice therapy is often recommended before more invasive procedures are tried.[11] Some also state that it is useful for mild symptoms and as an add-on to botox therapy[15] and others report success in more severe cases.[16] Laryngeal manual therapy, which is massaging of the neck and cervical structures, also shows positive results for intervention of functional dysphonia.[17]

Surgery

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A number of operations that cut one of the nerves of the vocal folds (the recurrent laryngeal nerve) has improved the voice of many for several months to several years but the improvement may be temporary.[18]

An operation called "selective laryngeal adductor denervation-rennervation (SLAD-R)" is effective specifically for adductor spasmodic dysphonia which has shown good outcomes in about 80% of people at 8 years.[13] Post-surgery voices can be imperfect and about 15% of people have significant difficulties.[13] If symptoms do recur this is typically in the first 12 months.[13] Another operation called "recurrent laryngeal nerve avulsion" has positive outcomes of 80% at three years.[15]

Another surgical option is a thyroplasty, which ultimately changes the position or length of the vocal folds. After thyroplasty there is an increase in both objective and subjective measures of speech.[19]

Botulinum toxin

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Botulinum toxin (Botox) is often used to improve some symptoms of spasmodic dysphonia. Whilst the level of evidence for its use is limited,[20] it remains a popular choice for many patients due to the predictability and low chance of long term side effects. It results in periods of some improvement. The duration of benefit averages 15-18 weeks before the patient returns to baseline.[19] Repeat injection is required to sustain good vocal production.[11] Possible side effects include breathiness of voice and choking on fluid,[21] as well as reduced speech volume[22]

  1. ^ da Cunha Pereira, G; de Oliveira Lemos, I; Dalbosco Gadenz, C; Cassol, M (21 July 2017). "Effects of Voice Therapy on Muscle Tension Dysphonia: A Systematic Literature Review". Journal of Voice : Official Journal of the Voice Foundation. 32 (5): 546–552. doi:10.1016/j.jvoice.2017.06.015. PMID 28739332. S2CID 44364291.
  2. ^ Ogawa, M; Inohara, H (22 August 2017). "Is voice therapy effective for the treatment of dysphonic patients with benign vocal fold lesions?". Auris, Nasus, Larynx. 45 (4): 661–666. doi:10.1016/j.anl.2017.08.003. PMID 28844607. S2CID 40764611.
  3. ^ Ribeiro, VV; Pedrosa, V; Silverio, KCA; Behlau, M (24 August 2017). "Laryngeal Manual Therapies for Behavioral Dysphonia: A Systematic Review and Meta-analysis". Journal of Voice : Official Journal of the Voice Foundation. 32 (5): 553–563. doi:10.1016/j.jvoice.2017.06.019. PMID 28844806. S2CID 12535772.
  4. ^ a b c d e f g h i j k l m n Cite error: The named reference NIH2017 was invoked but never defined (see the help page).
  5. ^ a b c d "Laryngeal Dystonia". NORD (National Organization for Rare Disorders). 2017. Archived from the original on 16 November 2016. Retrieved 16 July 2017.
  6. ^ Payne, S; Tisch, S; Cole, I; Brake, H; Rough, J; Darveniza, P (May 2014). "The clinical spectrum of laryngeal dystonia includes dystonic cough: observations of a large series". Movement Disorders : Official Journal of the Movement Disorder Society. 29 (6): 729–35. doi:10.1002/mds.25865. PMID 24753288. S2CID 28533915.
  7. ^ Castelon Konkiewitz, E; Trender-Gerhard, I; Kamm, C; Warner, T; Ben-Shlomo, Y; Gasser, T; Conrad, B; Ceballos-Baumann, AO (June 2002). "Service-based survey of dystonia in munich". Neuroepidemiology. 21 (4): 202–6. doi:10.1159/000059525. PMID 12065883. S2CID 11684033.
  8. ^ Schweinfurth, JM; Billante, M; Courey, MS (February 2002). "Risk factors and demographics in patients with spasmodic dysphonia". The Laryngoscope. 112 (2): 220–3. doi:10.1097/00005537-200202000-00004. PMID 11889373. S2CID 45780012.
  9. ^ Adler, CH; Edwards, BW; Bansberg, SF (November 1997). "Female predominance in spasmodic dysphonia". Journal of Neurology, Neurosurgery, and Psychiatry. 63 (5): 688. doi:10.1136/jnnp.63.5.688. PMC 2169807. PMID 9408119.
  10. ^ Albert, Martin L.; Knoefel, Janice E. (1994). Clinical Neurology of Aging. Oxford University Press. p. 512. ISBN 9780195071672. Archived from the original on 2017-09-08.
  11. ^ a b c Ludlow, CL (June 2009). "Treatment for spasmodic dysphonia: limitations of current approaches". Current Opinion in Otolaryngology & Head and Neck Surgery. 17 (3): 160–5. doi:10.1097/MOO.0b013e32832aef6f. PMC 2763389. PMID 19337127.
  12. ^ Grillone, GA; Chan, T (February 2006). "Laryngeal dystonia" (PDF). Otolaryngologic Clinics of North America. 39 (1): 87–100. doi:10.1016/j.otc.2005.11.001. PMID 16469657.
  13. ^ a b c d Chhetri, DK; Berke, GS (February 2006). "Treatment of adductor spasmodic dysphonia with selective laryngeal adductor denervation and reinnervation surgery" (PDF). Otolaryngologic Clinics of North America. 39 (1): 101–9. doi:10.1016/j.otc.2005.10.005. PMID 16469658. Archived (PDF) from the original on 2012-05-31.
  14. ^ Bressman, edited by Thomas T. Warner, Susan B. (2007). Clinical diagnosis and management of dystonia. London: Informa Healthcare. p. 111. ISBN 978-1-84184-317-9. {{cite book}}: |first= has generic name (help)CS1 maint: multiple names: authors list (link)
  15. ^ a b Wackym, James B. Snow,... P. Ashley (2009). Ballenger's otorhinolaryngology : head and neck surgery (17th ed.). Shelton, Conn.: People's Medical Pub. House/B C Decker. p. 918. ISBN 978-1-55009-337-7.{{cite book}}: CS1 maint: multiple names: authors list (link)
  16. ^ Klaben, Joseph C. Stemple, Leslie Glaze, Bernice Gerdeman (2000). Clinical voice pathology : theory and management (3. ed.). San Diego, Calif.: Singular Publ. Group. p. 368. ISBN 978-0-7693-0005-4.{{cite book}}: CS1 maint: multiple names: authors list (link)
  17. ^ Ribeiro, VV; Pedrosa, V; Silverio, KCA; Behlau, M (24 August 2017). "Laryngeal Manual Therapies for Behavioral Dysphonia: A Systematic Review and Meta-analysis". Journal of Voice : Official Journal of the Voice Foundation. 32 (5): 553–563. doi:10.1016/j.jvoice.2017.06.019. PMID 28844806. S2CID 12535772.
  18. ^ Cite error: The named reference NIH was invoked but never defined (see the help page).
  19. ^ a b van Esch, BF; Wegner, I; Stegeman, I; Grolman, W (February 2017). "Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients". Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 156 (2): 238–254. doi:10.1177/0194599816675320. PMID 27803079. S2CID 4332852.
  20. ^ Watts, C; Nye, C; Whurr, R (February 2006). "Botulinum toxin for treating spasmodic dysphonia (laryngeal dystonia): a systematic Cochrane review". Clinical Rehabilitation. 20 (2): 112–22. doi:10.1191/0269215506cr931oa. PMID 16541931. S2CID 34806668.
  21. ^ Srirompotong, S; Saeseow, P; Taweesaengsuksakul, R; Kharmwan, S; Srirompotong, S (December 2006). "Botulinum toxin injection for treatment of spasmodic dysphonia: experience at Srinagarind Hospital". Journal of the Medical Association of Thailand = Chotmaihet Thangphaet. 89 (12): 2077–80. PMID 17214059.
  22. ^ Boutsen, F; Cannito, MP; Taylor, M; Bender, B (June 2002). "Botox treatment in adductor spasmodic dysphonia: a meta-analysis". Journal of Speech, Language, and Hearing Research : JSLHR. 45 (3): 469–81. doi:10.1044/1092-4388(2002/037). PMID 12069000.
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