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Vocal aging and adductor spasmodic dysphonia: Response to botulinum toxin injection  [cached]
Michael P Cannito,Joel C Kahane,Lesya Chorna
Clinical Interventions in Aging , 2008,
Abstract: Michael P Cannito, Joel C Kahane, Lesya ChornaSchool of Audiology and Speech-Language Pathology, The University of Memphis, Memphis, TN, USAAbstract: Aging of the larynx is characterized by involutional changes which alter its biomechanical and neural properties and create a biological environment that is different from younger counterparts. Illustrative anatomical examples are presented. This natural, non-disease process appears to set conditions which may influence the effectiveness of botulinum toxin injection and our expectations for its success. Adductor spasmodic dysphonia, a type of laryngeal dystonia, is typically treated using botulinum toxin injections of the vocal folds in order to suppress adductory muscle spasms which are disruptive to production of speech and voice. A few studies have suggested diminished response to treatment in older patients with adductor spasmodic dysphonia. This retrospective study provides a reanalysis of existing pre-to-post treatment data as function of age. Perceptual judgments of speech produced by 42 patients with ADSD were made by two panels of professional listeners with expertise in voice or fluency of speech. Results demonstrate a markedly reduced positive response to botulinum toxin treatment in the older patients. Perceptual findings are further elucidated by means of acoustic spectrography. Literature on vocal aging is reviewed to provide a specific set of biological mechanisms that best account for the observed interaction of botulinum toxin treatment with advancing age.Keywords: vocal aging, adductor spasmodic dysphonia, botulinum toxin, voice quality, speech fluency
Tratamento médico e fonoaudiológico da disfonia espasmódica: uma revis o bibliográfica Medical treatment and speech therapy for spasmodic dysphonia: a literature review  [cached]
Eliana Maria Gradim Fabron,Viviane Cristina de Castro Marino,Talyssa de Carvalho Nóbile,Luciana Tavares Sebasti?o
Revista CEFAC , 2013,
Abstract: A disfonia espasmódica (DE) é um distúrbio vocal caracterizado por voz tensa-estrangulada, com quebras de sonoridade e que compromete a comunica o do indivíduo. O objetivo deste estudo é apresentar uma revis o bibliográfica dos tratamentos médico e fonoaudiológico proposto para a DE no período entre 2006 e 2010. Os tratamentos descritos foram: inje o de toxina botulínica (TB), miectomia, neurectomia, denerva o e reinerva o laríngea seletiva adutora, tireoplastia, miotermia tiroaritenóidea com radiofrequência, inje o de lidocaína, homeopatia e tratamento fonoaudiológico (fonoterapia). O uso de inje o de TB mostrou resultados que indicaram a satisfa o dos pacientes tratados, embora alguns dos artigos apontassem a necessidade de reaplica o da toxina frequentemente, como desvantagem. Os procedimentos cirúrgicos foram considerados duradouros e indicados para os pacientes que n o quiseram se submeter às aplica es de TB. Tais estudos, no entanto, apresentaram contingência de pacientes restrita e os resultados foram baseados, na maioria das investiga es, no julgamento dos próprios pacientes sobre a sua qualidade vocal. Os tratamentos, com uso de lidocaína e homeopatia, mostraram resultados positivos em rela o à qualidade vocal dos pacientes e foram sugeridos como uma op o, também, para aqueles que n o gostariam de ser submetidos ao tratamento cirúrgico ou à aplica o de TB. Os poucos estudos que reportam fonoterapia assinalaram bons resultados quando a mesma foi associada à inje o de TB, mostrando a escassez de informa es nesta área. Futuras pesquisas envolvendo a fonoterapia no tratamento da DE s o necessárias. Spasmodic dysphonia (SD) is a voice disorder characterized by a strained-strangled voice, with sound breaks and has implications in one's communication. The purpose of this study is to present a bibliographic review of the speech therapy and medical treatment suggested for SD from 2006 to 2010. The speech therapy and medical treatments described are: botulinum toxin injection, myectomy, neurectomy, denervation and reinnervation selective laryngeal adductor, thyroplasty, radiofrequency thyroarytenoid myothermy, injection of lidocaine, homeopathy and speech therapy. The use of botulinum toxin injection showed results that indicated the satisfaction of the patients who were treated, although some of the articles presented the frequent need of reapplication of the toxin as a disadvantage. The surgical procedures were considered long-lasting and indicated to patients who didn't want to get botulinum toxin injections. The studies, however, prese
Botulinum toxin efficacy in the treatment of patients with spasmodic dysphonia  [PDF]
Svetel Marina,Vasi? Milan,Tomi? Gordana,Stankovi? Predrag
Vojnosanitetski Pregled , 2007, DOI: 10.2298/vsp0710671s
Abstract: Background/Aim. Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80 100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. Methods. The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12 16 units each. In our study we applied indirect technique originally developed by Ho evar and Pirto ek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. Results. The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index (VHI) that was rated as rather significant one (t = 3.562; p = 0.006). Conclusion. Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation.
Qualidade de Vida em Voz: estudo na doen a de Parkinson idiopática e na Disfonia Espasmódica Adutora Quality of life in voice: a study in Parkinson's disease and in adductor spasmodic dysphonia  [cached]
Bárbara Pereira Lopes,Riviana Rodrigues das Gra?as,Iara Barreto Bassi,Ant?nio Lobo de Rezende Neto
Revista CEFAC , 2012, DOI: 10.1590/s1516-18462012005000072
Abstract: OBJETIVO: avaliar o impacto causado pela altera o vocal na qualidade de vida (QV) dos pacientes com doen a de Parkinson (DP) idiopática e com disfonia espasmódica adutora (DEA). MéTODO: o estudo foi realizado com 56 indivíduos do sexo feminino, dos quais 28 compunham o grupo controle; 14, o grupo de DEA, no período anterior ao tratamento com toxina botulínica; e 14, o grupo de DP idiopática. Os participantes preencheram o questionário de Qualidade de Vida em Voz (QVV) validado para o português brasileiro. Para verificar a diferen a entre as médias dos grupos foi utilizado o método de análise de variancia por postos de Kruskal-Wallis e o teste de Tamhane para compara es múltiplas, com significancia <0,05. RESULTADOS: as médias de idade dos grupos foram 66,18 para o grupo controle, 67,21 DP e 59,7 DEA, n o havendo diferen a estatística entre as médias. No protocolo QVV as médias dos domínios sócio-emocional, físico e escore total foram maiores para o grupo controle, seguido pelo grupo de DP idiopática e por fim o grupo da DEA, sendo a diferen a entre elas estatisticamente significante. Além disso, houve diferen a estatística para cada par de grupos, referente aos domínios do protocolo QVV, exceto no que se refere ao par controle e DP idiopática, no domínio sócio emocional (p=0,076). CONCLUS O: o maior impacto negativo na QV relacionado à voz está nos indivíduos com DEA, seguido por aqueles com DP idiopática e por fim os indivíduos do grupo controle. PURPOSE: to evaluate the impact of voice disorders on quality of life of patients with idiopathic Parkinson's disease and with adductor spasmodic dysphonia. METHOD: the study consisted of 56 females, 28 in the control group; 14, the adductor spasmodic dysphonia group in the period prior to treatment with botulinum toxin; and 14, the group of idiopathic Parkinson's disease. The participants filled in the Voice-Related Quality of life (V-RQOL) questionnaire validated for Brazilian Portuguese. To check the difference between averages of the groups it was used the method of analysis of variance by Kruskal-Wallis and Tamhane test for multiple comparisons, with significance <0.05. RESULTS: the average age of the groups were 66.18 for the control group, 67.21 for the Parkinson's disease group and 59.7 for the adductor spasmodic dysphonia group, with no statistical difference between the groups. In the V-RQOL protocol the mean domain social-emotional, physical functioning and total score were higher in the control group, followed by group of Parkinson's disease and, finally, the group of adductor spasmodic dysphonia
Qualidade de Vida em Voz: estudo na doen a de Parkinson idiopática e na disfonia espasmódica adutora Quality of life in voice: a study in Parkinson's disease and in adductor spasmodic dysphonia
Bárbara Pereira Lopes,Riviana Rodrigues das Gra?as,Iara Barreto Bassi,Ant?nio Lobo de Rezende Neto
Revista CEFAC , 2013,
Abstract: OBJETIVO: avaliar o impacto causado pela altera o vocal na qualidade de vida (QV) dos pacientes com doen a de Parkinson (DP) idiopática e com disfonia espasmódica adutora (DEA). MéTODO: o estudo foi realizado com 56 indivíduos do sexo feminino, dos quais 28 compunham o grupo controle; 14, o grupo de DEA, no período anterior ao tratamento com toxina botulínica; e 14, o grupo de DP idiopática. Os participantes preencheram o questionário de Qualidade de Vida em Voz (QVV) validado para o português brasileiro. Para verificar a diferen a entre as médias dos grupos foi utilizado o método de análise de variancia por postos de Kruskal-Wallis e o teste de Tamhane para compara es múltiplas, com significancia <0,05. RESULTADOS: as médias de idade dos grupos foram 66,18 para o grupo controle, 67,21 DP e 59,7 DEA, n o havendo diferen a estatística entre as médias. No protocolo QVV as médias dos domínios sócio-emocional, físico e escore total foram maiores para o grupo controle, seguido pelo grupo de DP idiopática e por fim o grupo da DEA, sendo a diferen a entre elas estatisticamente significante. Além disso, houve diferen a estatística para cada par de grupos, referente aos domínios do protocolo QVV, exceto no que se refere ao par controle e DP idiopática, no domínio sócio emocional (p=0,076). CONCLUS O: o maior impacto negativo na QV relacionado à voz está nos indivíduos com DEA, seguido por aqueles com DP idiopática e por fim os indivíduos do grupo controle. PURPOSE: to evaluate the impact of voice disorders on quality of life of patients with idiopathic Parkinson's disease and with adductor spasmodic dysphonia. METHOD: the study consisted of 56 females, 28 in the control group; 14, the adductor spasmodic dysphonia group in the period prior to treatment with botulinum toxin; and 14, the group of idiopathic Parkinson's disease. The participants filled in the Voice-Related Quality of life (V-RQOL) questionnaire validated for Brazilian Portuguese. To check the difference between averages of the groups it was used the method of analysis of variance by Kruskal-Wallis and Tamhane test for multiple comparisons, with significance <0.05. RESULTS: the average age of the groups were 66.18 for the control group, 67.21 for the Parkinson's disease group and 59.7 for the adductor spasmodic dysphonia group, with no statistical difference between the groups. In the V-RQOL protocol the mean domain social-emotional, physical functioning and total score were higher in the control group, followed by group of Parkinson's disease and, finally, the group of adductor spasmodic dysphonia
Aplica o da técnica de emiss o em tempo máximo de fona o em paciente com disfonia espasmódica adutora: relato de caso Applying the technique of sustained maximum phonation time in a female patient with adductor spasmodic dysphonia: case report
Luiz Alberto Alves Mota,Catarina Matos Brito Santos,Jamile Meira de Vasconcelos,Bruno Calife Mota
Revista da Sociedade Brasileira de Fonoaudiologia , 2012, DOI: 10.1590/s1516-80342012000300019
Abstract: A Disfonia Espasmódica Adutora é uma desordem neurológica do processamento motor central, caracterizada por contra es involuntárias e inapropriadas da musculatura fonatória, produzindo uma hiperadu o das pregas vocais, o que promove uma voz trêmula, entrecortada e tensa-estrangulada. O objetivo deste estudo foi descrever os parametros vocais, acústicos e laríngeos pré e pós-tratamento fonoaudiológico realizado por meio da aplica o da Técnica de Emiss o em Tempo Máximo de Fona o (TETMF) em paciente com Disfonia Espasmódica de Adu o. Esta técnica tem como objetivo promover o aumento da resistência glótica, melhorar a estabilidade fonatória e adequar a coapta o glótica. Participou deste estudo de caso uma paciente de 66 anos de idade, gênero feminino, com Disfonia Espasmódica Adutora. A paciente foi submetida à avalia o otorrinolaringológica e fonoaudiológica pré e pós-aplica o da TETMF. Foi verificada modifica o de parametros vocais, acústicos e laríngeos, tais como a classifica o da disfonia de G3R1B1A0S3I3 para G2R1B1A0S2I2, pitch de grave a adequado, tra ado espectrográfico instável para mais estável e expressivo aumento da frequência fundamental média e da intensidade vocal média, além da melhora da eficiência glótica com o fechamento da fenda glótica anteroposterior. A terapia fonoaudiológica com a aplica o da TETMF foi considerada uma adequada op o de tratamento para o caso, tendo em vista os resultados alcan ados, com destaque para a qualidade vocal e estabilidade fonatória. Ressalta-se a importancia de novos estudos para comprova o da eficácia da técnica no tratamento da Disfonia Espasmódica Adutora. Adductor Spasmodic Dysphonia (ASD) is a neurological disorder of central motor processing, characterized by involuntary and inappropriate contractions of the phonatory muscles, producing hyperadduction of the vocal folds, which causes a tremulous, faltering and strained-strangled voice. The aim of this study was to describe the vocal, acoustic and laryngeal parameters measured for a female patient with ADS pre and post speech therapy using the Technique of Sustained Maximum Phonation Time (SMPT). This technique aims to promote increase in glottal resistance, improve phonatory stability, and enhance glottal coaptation. A 66-year-old female patient with ASD took part in this study. She was submitted to otorhinolaryngologic and speech-language assessment before and after the application of the SMPT technique. The results showed modification of vocal, acoustic and laryngeal parameters, such as re-classifying her dysphonia from G3R1B1A0S3I3 to
Impacto na qualidade vocal da miectomia parcial e neurectomia endoscópica do músculo tireoaritenóideo em paciente com disfonia espasmódica de adu??o
Tsuji, Domingos Hiroshi;Chrispim, Fernanda Silveira;Imamura, Rui;Sennes, Luiz Ubirajara;Hachiya, Adriana;
Revista Brasileira de Otorrinolaringologia , 2006, DOI: 10.1590/S0034-72992006000200019
Abstract: impact in vocal quality in partial myectomy and neurectomy endoscopic of thyroarytenoid muscle in patients with adductor spasmodic dysphonia the adductor spasmodic dysphonia is a severe vocal disorder characterized by muscle laryngeal spasms during speech, producing phonatory breaks, forced, strained and strangled voice. its symptoms come from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold strain, pressed one against another and increased glottic resistance. aim: report the results in the impact in vocal quality in neurectomy of the thyroarytenoid branch of the inferior laryngeal nerve by endoscopic route associated with partial myectomy of the thyroarytenoid muscle with co2 laser. material e methods: the surgery was done in 07 patients ( 06 females and 01 male), aged 22 to 75, with adductor spasmodic dysphonia. they were submitted to vhi (voice handicap index) before and after surgery. results and conclusions: the vocal improvement was obtained in all studied patients, deterioration in vocal quality after surgery was not noticed. there was evident difference in the vhi before and after surgery. this surgical thecnique proved to be efficient and innovative in the treatment of adductor spasmodic dysphonia.
Spasmodic dysphonia: description of the disease and associated neurologic disorders  [cached]
Coelho, Marina Serrato,Macedo, Evaldo,Oliveira, Marcela Schmidt Braz de,Lobo, Paulo
International Archives of Otorhinolaryngology , 2010,
Abstract: Introduction: Spasmodic dysphonia (SD) is a problem that affects speech and vocalization, one of the most devastating disorders of oral communication. It is characterized by vocal quality tensaestrangulada, harshly and / or interspersed with abrupt vocal attack and a great tension in the vocal tract. The etiology of spasmodic dysphonia is unclear. Some authors point to psychogenic causes, neurological or even unknown. Objective: To assess the prevalence of muscular dystonias and other neurological symptoms in patients with ED. Method: A retrospective study of 10 cases with diagnosis of ED for symptoms and neurological disorders associated. Results: There was a significant predominance of the disease in females (9:1). The average age of onset of symptoms was 32 years, ranging between 14 and 60 years. The mean disease duration was 10 years. Among the patients, 87.5% had a diagnosis of disorders of movement made by a neurologist, including orofacial dystonias (50%), essential tremor (50%) and spastic paraparesis (12%). Conclusion: The presence of movement disorders followed almost all cases of spasmodic dysphonia. More studies are needed to clarify the pathophysiological basis of disease.
Spasmodic dysphonia may respond to bilateral thalamic deep brain stimulation
M Lyons, C Adler, S Bansberg, V Evidente
African Journal of Neurological Sciences , 2009,
Abstract: Background Spasmodic dysphonia is a primary focal dystonia manifested by loss of control of the vocal muscles during speech secondary to laryngeal muscle spasms. The pathophysiology is not well understood. Deep brain stimulation surgery (DBS) for other focal dystonias has been well reported. Methods We report the first case of bilateral thalamic DBS improving spasmodic dystonia (SD) in a patient with essential tremor. Results This case demonstrates the beneficial of effects of bilateral thalamic DBS for both ET of the hands and AdSD of the vocal cords. Conclusions The potential pathophysiologic mechanisms of this finding are discussed.
Distonia laríngea: relato de caso e tratamento com toxina botulínica
Santos, Victor José Barbosa;Mattioli, Fernando Marcos;Mattioli, Wellerson Marcos;Daniel, Renata Jacob;Cruz, Vicente Paulo Miranda;
Revista Brasileira de Otorrinolaringologia , 2006, DOI: 10.1590/S0034-72992006000300022
Abstract: laryngeal dystonia or spasmodic dysphonia is characterized by involuntary and innapropiate spasms of vocal muscles, having the adductor type as the most common one. it is chacterized by strain-strangled voice with pitch breaks. diagnosis is made by means of videolaryngostroboscopic exam. the treatment of choice is done with botulinum toxin directly injected in the muscles responsible for the mismatched movement. the aim of this study is to report on an adductor- type dysphonia patient and to discuss the advantages and observations about this treatment reported in the literature.
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