What are Common Treatment Options for Spasmodic Dysphonia?
Once diagnosed, it is helpful to discuss treatment options with your treatment team (otolaryngologist and speech language pathologist/voice therapist). Botulinum toxin injections and/or voice therapy are typically good starting points. Treatment will differ for each person, however, and each individual may benefit from a different treatment program.
Botulinum Toxin Injections
Botulinum toxin is injected into the laryngeal muscles that control the opening (abduction) and closing (adduction) of the vocal folds. The most common brand currently used for spasmodic dysphonia is Botoxand it works to eliminate spasms of the muscles that control the vocal folds by blocking nerve impulses at the muscle receptor site which normally signal the muscle to contract. The specific laryngeal muscle injected will depend on the type of SD; typically the thryoarytenoid (TA) muscle for adductor type and the posterior cricoarytenoid (PCA) for abductor type This weakening effect is only temporary and thus, Botox injections need to be repeated. The duration of benefit of Botox varies from person to person but the average length is 3-4 months.. Individuals may experience temporary side effects from Botoxinjections including breathiness, difficulty swallowing, or pain/soreness at the site of injection. Individuals may be given strategies to cope with these effects by the treating ENT or speech language pathologist at the time of injection. These side effects typically do not last long, but may be more significant as the dosage of Botox increases. Some ENTs provide the option of unilateral injections, through which only one side of the voice mechanism is injected. This results in less powerful or less duration of the Botoxeffect, but also with less side effects following the injection. Discussion of unilateral versus bilateral injections, and specific dosage of Botox will be based on the wishes of the person, recommendations of the treating professionals, and individual responses from the past few Botox injections. Look out for a more detailed post on Botox and on determining optimal dose or treatment plan here soon!
Voice Therapy
Voice therapy cannot cure spasmodic dysphonia, as it is a neurological disorder; however, people may find benefit to re-coordinating the speech subsystems (breathing patterns, phonation, resonance, articulation) and to work in a more efficient way to be able to better manage symptoms of SD including breaks, strain, roughness, breathiness, and effortful voicing. Voice therapy for spasmodic dysphonia is provided by a speech language pathologist (specialized voice therapist) and can teach a person behavioral strategies to better manage SD symptoms. Voice therapy should incorporate individual goals such as strategies for speaking in groups, speaking on the phone, speaking with less effort, etc. It can provide individuals with education on spasmodic dysphonia, appropriate vocal health habits, in addition to counseling for coping with the quality of life impairments of the disorder. Voice therapy has also been shown by some studies to be an effective adjunct to Botoxinjections.
Surgical Options
Several surgical options exist to treat spasmodic dysphonia. The majority of surgeries are designed to treat adductor spasmodic dysphonia. In Selective Laryngeal Adductor Denervation-Reinnervation (SLAD-R) involves cutting the recurrent laryngeal nerve which innervates the thyroarytenoid and lateral cricoarytenoid muscles and reinnervating the muscles with a different nerve. In Type II Thyroplasty surgery, the surgeon separates the vocal folds slightly, to result in less severe spasms. This may result in a weaker or breathier voice, but with less severe spasms. Several studies have shown limitation in maintenance of long term results. For abductor spasmodic dysphonia, a procedure call Bilateral Vocal Fold Medialization can be considered where a silastic implant or an insoluble injection material is placed either through a surgical incision or with an injection through the front of the neck. More conservative options like voice therapy or Botox are generally recommended over surgery. If surgery is an option, potential risks and benefits should be discussed with the treating laryngologist.