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Spasmodic dysphonia (SD) remains one of the most difficult of laryngeal pathologies to treat. With limited role for speech therapy, various surgical modalities have been tried with various success rates. The objective of the study is to report the results of vocal outcome after thyroarytenoid myoneurectomy in patients of adductor spasmodic dysphonia (ASD). 15 patients of ASD were selected. GRBAS, and voice handicap index (VHI) were used for perceptual evaluation of voice. Thyroarytenoid myoneurectomy was performed by vaporizing the muscular layer of the vocal fold with CO2 laser, at an intensity of 6 W with 1.2 mm diameter in scanner mode. Voice analysis was repeated at 12, 24 and 48 months follow-up. Preoperative GRBAS scores and VHI score of all the patients were poor. At 12 months 12/15 (80 %) patients having strain score of 0. There was marked improvement in VHI scores at 6 months. 10/15 (67 %) patients have been followed up for 24 months. 5/10 (50 %) patients have strain (S) value of 0. VHI scoring of 5/10 (50 %) patients was <30. Two of the four patients completed 48 months follow-up had a strain (S) value of 0, one patient has strain value of 1 and one patient had strain value of 2. 2/4 patients had VHI score of <30; one patient had that of 40. Trans-oral CO2 laser thyroarytenoid myoneurectomy shows significant long-term improvement in voice quality in terms of reduced speech brakes, effort and strain in voice.

Objective To assess the results of endoscopic laser surgery in cases of bilateral abductor palsy on basis of respiration, preservation of voice (phonation) and swallowing.Methods This retrospective study includes 48 patients (34 males and 14 females) from 5 years to 68 years of age at the time of intervention. 41 cases were operated with subtotal arytenoidectomy and 7 with unilateral posterior cordectomy. 32 patients were operated with tracheostomy and 16 with combination of intuabtion and jet ventilation.Results 29 out of 32 tracheostomised patients were decannulated (91%). Respiration was adequate for daily routine activities in most of the operated patients. Phonation was normal to near normal in 32 cases out of the operated 34 adult patients (95%). Most of the patients had normal swallowing following surgery.Conclusion Subtotal arytenoidectomy with endoscopic laser surgery in cases of bilateral abductor paralysis has established its place as a preferred surgical method to obtain good respiration, phonation and swallowing. It minimizes the surgical time, hospital stay and morbidity.