What is the diagnosis and treatment for spasmodic dysphonia with stridor?

From the Guidelines

Spasmodic dysphonia with stridor requires prompt evaluation and treatment with botulinum toxin injections, as recommended by the most recent clinical practice guidelines 1.

Key Considerations

• The condition involves abnormal vocal cord movements causing breathing difficulties, and treatment should focus on improving quality of life and reducing airway symptoms.
• Botulinum toxin injections are the recommended treatment for spasmodic dysphonia and other types of laryngeal dystonia, as they have been shown to be effective in reducing symptoms and improving quality of life 1.
• Voice therapy with a speech-language pathologist is an essential complementary treatment to improve vocal technique and breathing coordination.
• In severe cases with significant airway compromise, surgical interventions such as posterior cordotomy or type II thyroplasty may be considered.

Treatment Approach

• Patients should be evaluated by an otolaryngologist (ENT specialist) to determine the underlying cause of their dysphonia and to develop a treatment plan.
• Botulinum toxin injections should be offered as a treatment option for patients with spasmodic dysphonia, as they have been shown to be effective in reducing symptoms and improving quality of life 1.
• Patients should avoid triggers that worsen symptoms, including stress, excessive voice use, and caffeine.
• The condition results from neurological dysfunction affecting laryngeal muscle control, causing adductor or abductor spasms of the vocal cords.
• Stridor occurs specifically with abductor spasmodic dysphonia when the vocal cords cannot separate properly during breathing.

Important Considerations

• While not curable, these treatments can significantly improve quality of life and reduce dangerous airway symptoms.
• Clinicians should document resolution, improvement, or worsened symptoms of dysphonia, or change in quality of life (QOL) of patients with dysphonia after treatment or observation 1.
• Patients should be informed about control/preventive measures to manage their condition and improve their quality of life 1.

From the Research

Spasmodic Dysphonia Stridor

• Spasmodic dysphonia (SD) is a neurological voice disorder that causes involuntary spasms of the vocal cord muscles, resulting in strained and strangled voice quality, as in adductor spasmodic dysphonia, or weak, quiet, and breathy, as in abductor spasmodic dysphonia 2.
• Stridor, a high-pitched sound while inhaling, is present in some patients with SD, and in some cases, it is the sole manifestation of the laryngeal dystonia 3.
• Botulinum toxin (BTX) injections are widely used to treat both adductor and abductor forms of SD, and have been found to be effective in controlling the dystonic symptoms in most patients 4, 3, 5.
• The treatment outcome of BTX injections can depend on several factors, including the type of SD, age, and dosage, with adductor SD generally having a better treatment outcome than abductor SD 3.
• Adverse effects of BTX injections can include mild breathiness, coughing on fluids, and stridor, but severe adverse events are rare 4, 3.
• Other treatment modalities, such as surgery, implantable electrical stimulation devices, and deep brain stimulation, are also being investigated for the treatment of SD 6.