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Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

DOI: 10.1186/1746-160x-5-20

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Abstract:

Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven.Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections.Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia.Adductor spasmodic dysphonia (ADSD) is a focal dystonia of the laryngeal musculature, causing abrupt, intermittent and involuntary vocal folds spasms producing a strained and strangled speech pattern. It is idiopathic in nature and may reflect abnormalities in central motor processing [1].The cardinal signs of ADSD are effortful vocal straining and harshness, quaver and voice arrest due to laryngospasm in the midst of non-effortful phonatory periods. It is described as "speaking whilst being strangled". Examination of the larynx may reveal true and false vocal folds hyper-adduction with laryngeal elevation and its attendant effects on speech. ADSD, a disabling disorder of voice, is characterised by involuntary disruption of phonation with functional, social and emotional consequences [1].Botulinum toxin is the treatment of choice for ADSD and has been in use since the late 1980's [2-5]. It improves the patients' perception of dysphonia, mental health and their social function [6]. The American Academy of Otolaryngology-Head and Neck Surgery recognizes treatment with Botulinum toxin as t

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