Objective: To report two cases of adductor spasmodic dysphonia that treated with botulinum toxin A under fiber laryngoscope combined with needle electromyography guidance.

Background: Spasmodic dysphonia is a kind of disease caused by abnormal spasm of the laryngeal muscles that leads to unusual vocal cord movements. It is characterized by abnormal tones in the pronunciation, accompanied with tremor and interruption of voice. Sometimes it is associated with spasmodic torticollis, blepharospasm, limb dystonia, or oromandibular dystonia. The current treatments include speech training, psychotherapy, oral medication, botulinum toxin injection and surgical treatments. Local injection of botulinum toxin A (Btx-A) is the first choice for the treatment of spasmodic dysphonia.

Methods: Two patients were both diagnosed with adductor spasmodic dysphonia. One patient was a 57- year-old man who suffered from “blepharospasm accompanied with spasmodic dysphonia” for 3 years. The other patient was a 52-year-old woman who had been diagnosed as “Meige syndrome accompanied with spasmodic dysphonia” for 4 years. The main clinical manifestations of both patients included increased blinking, involuntary eye closure, difficulty of inspiration and abnormal laryngeal sound when inhaled. No abnormalities showed in their examinations of barium swallow, chest CT, and head MRI. Fibrotic laryngoscopy showed bilateral vocal cord tension, excessive adduction, and limited abduction. Previous treatments with risperidone, aripiprazole, baclofen, trihexyphenidyl had no effects. And we performed Btx-A (Allergen Pharmaceuticals Ltd., Westport, Ireland) injection, with 50 units into the bilateral orbicularis muscles and 2 units into the right thyroarytenoid muscle. The right side thyroarytenoid muscle was injected under needle electromyography combined with fiber laryngoscope.

Results: Two days after Btx-A treatment, both patients complained remarkable improvement of eye symptoms, inspiration and laryngeal sound. Phonation had almost recovered to the normal state in both patients 5-7 days after treatment. The alleviation of symptoms could last more than 1 month. No aphonia and dysphagia happened during follow-ups.

Conclusions: Fibrotic laryngoscopy is necessary for diagnosis of different types of spasmodic dysphonia. This study showed 2 units of Btx-A injection into the unilateral thyroarytenoid muscle could be an efficient and safe method for treatment of adductor spasmodic dysphonia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-a-injection-for-treatment-of-adductor-spasmodic-dysphonia-under-guidance-of-fiber-laryngoscope-combined-with-needle-electromyography-2-case-reports/