A possible surgical treatment for abductor spasmodic dysphonia
Traditional treatment for abductor spasmodic dysphonia—botulinum toxin injection into the posterior cricoarytenoid muscle—can be both technically challenging and uncomfortable. Due to the difficulty of needle placement, it is often unsuccessful. The use of bilateral vocal fold medialization is being revisited as a possible treatment for AbSD.
A retrospective case review by Drs. Gerald Berke and Karuna Dewan of all cases of abductor spasmodic dysphonia treated in a tertiary care laryngology practice with bilateral vocal fold medialization over a 10-year period was performed.
This procedure is done by bilaterally medializing the vocal folds. A silastic implant or an insoluble injection material is placed. This can either be done through a surgical incision or with an injection through the front of the neck. By preventing the vocal folds from abducting the maximum amount, we reduce the symptoms created by the spasms.
The Voice Handicap Index and the Voice-Related Quality of Life surveys were utilized to assess patient satisfaction with voice outcome. Six patients with abductor spasmodic dysphonia treated with bilateral vocal fold medialization were identified. Disease severity ranged from mild to severe. All six patients reported statistically significant improvement in nearly all Voice Handicap Index and Voice-Related Quality of Life parameters. They reported fewer voice breaks and greater ease of communication. Results were noted immediately and symptoms continue to be well controlled for many years following medialization.
Bilateral vocal fold medialization is a safe and effective treatment for abductor spasmodic dysphonia. It is performed under local anesthesia and provides phonation improvement in the short and long term.