Adductor spasmodic dysphonia: Botulinum toxin a injections or laser thyroarytenoid myoneurectomy? A comparison from the patient perspective

Abstract

Objectives/Hypothesis The current gold standard of therapy for adductor spasmodic dysphonia (AdSD) is injection of botulinum toxin A (BTX) in the adductor musculature. A surgical procedure could potentially offer more stable and long‐lasting voice quality. In this study, we report the long‐term results of endoscopic laser thyroarytenoid (TA) myoneurectomy versus BTX treatment in the same patients with AdSD. Study Design Retrospective case series. Methods Between July 2013 and September 2016, a total of 22 patients with AdSD were included. Voice outcomes were measured using the Voice Handicap Index and a Likert‐scale patient‐reported voice questionnaire. Data were obtained for each patient at four time points: preoperatively with and without BTX and twice postoperatively at 3 months (short term) and 12 months (long term). Results No statistically significant differences were found between voice outcome after BTX injection and the short‐ and long‐term postoperative voice outcomes for the group as a whole. During postoperative follow‐up, 10 of the 22 patients (45%) needed a second procedure after an average of 18 months (interquartile range, 13–22 months) due to recurrence of their original voice problem. Conclusions The TA myoneurectomy showed encouraging results, comparable to BTX after follow‐up of 12 months for the group as a whole. However, after good results initially, voice deterioration was seen in 45% of the patients who all underwent a second procedure. These preliminary results provide important insights into the value of TA myoneurectomy as a potential definite treatment for a select group of patients with AdSD. Further research might explore long‐term results after revision surgery. Level of Evidence 4 Laryngoscope, 130:741–746, 2020

Validation of the Communicative Participation Item Bank as an Outcome Measure for Spasmodic Dysphonia

“…The main surgical alternative to botulinum toxin injection is selective laryngeal adductor denervationreinnervation (SLAD-R) surgery which, though first described in 1999, has not been widely adopted by the laryngology community. 6,7 More recently, novel treatments such as sodium oxybate for alcohol responsive patients, 8 neuromodulation of laryngeal innervation with an implantable electrical stimulator device or a vibration collar, 9,10 and laser thyroarytenoid myoneurectomy 11 have been described with encouraging preliminary outcomes but limited long-term results. Outcomes reported for these treatments were measured by tools not validated to accurately represent the severity of the impact of SD on patients' daily communication function.…”

Durability of Titanium Implants Following Type II Thyroplasty for Adductor Type Spasmodic Dysphonia

“…Other surgery options for ADSD are available, such as thyroarytenoid muscle myoneurectomy (TAM) and selective laryngeal adductor denervation-reinnervation surgery (SLAD-R), which are performed under general anesthesia. Schuering has reported a 55% success rate for TAM (45% had additional TAM), 18 whereas Chhetri has reported a postoperative VHI-10 score of less than 10 in 57% of the patients. 22 Considering the results from these reports, the success rates of T2T, TAM, and SLAD-R could be similar.…”

“…Although some mechanical exams, such as acoustic and aerodynamic tests, are common for objective vocal function evaluation, they are not appropriate for severe ADSD cases due to the impossibility of speaking continuous vowels. Therefore, exams using scoring systems, such as VHI‐10, VAS, GRBAS, and distinctive systems, are used for evaluating the improvement in vocal function 16–19 . We selected VHI‐10 for this study because of its reliability, but we consider that a simple comparison of its mean scores is ineligible as described above.…”

Use of Botulinum Toxin in Spasmodic Dysphonia: A Review of Recent Studies

“…A study concluded that surgical procedures such as endoscopic laser thyroarytenoid myoneurectomy can potentially offer more stable and long-lasting voice quality compared to btx injections. However, in the study, 45% of patients showed deterioration after 12 months and needed a second procedure, which poses the question of whether it is comparatively a viable alternative to btx injections [ 14 ].…”