Overview
Spastic dysphonia, characterized by involuntary adduction of the vocal folds leading to strained and dysphonic speech, often lacks definitive etiological factors and responds variably to non-surgical interventions 2.Diagnosis
Clinical presentation includes strained, strangled voice quality and potential facial grimaces 4.
No specific diagnostic tests; diagnosis is primarily clinical 2.
Speech therapy trials recommended before surgical evaluation 3.Management
First-line: Voice therapy aimed at symptom management; efficacy varies among patients 23.
Adjunctive treatments:
- Inspiratory speech (IS) as a non-invasive option for improved fluency, though voice quality is compromised 1.
- Selective section of the adductor branch of the recurrent laryngeal nerve, preserving abductor function, offers significant improvement for some patients 3.
- Complete recurrent laryngeal nerve section with postoperative speech therapy can restore a near-normal voice in about half of patients 4.Special Populations
Pregnancy: Not addressed in provided abstracts.
Pediatrics: Not addressed in provided abstracts.
Elderly: Not addressed in provided abstracts.
Comorbidities: No specific considerations mentioned for comorbidities 234.Key Recommendations
Conduct a trial of speech therapy before considering surgical interventions for spastic dysphonia (Evidence: Moderate 3).
Evaluate patients with inspiratory speech as a potential non-invasive management strategy, particularly for those prioritizing fluency over voice quality (Evidence: Weak 1).
Selective section of the adductor branch of the recurrent laryngeal nerve may be considered for patients unresponsive to voice therapy, with careful preoperative evaluation and patient counseling on expected outcomes (Evidence: Moderate 3).
For patients not responding to conservative measures, complete recurrent laryngeal nerve section followed by postoperative speech therapy can lead to significant improvement in voice quality for approximately half of patients (Evidence: Moderate 4).References
1 Harrison GA, Davis PJ, Troughear RH, Winkworth AL. Inspiratory speech as a management option for spastic dysphonia. Case study. The Annals of otology, rhinology, and laryngology 1992. link
2 Izdebski K, Dedo HH, Boles L. Spastic dysphonia: a patient profile of 200 cases. American journal of otolaryngology 1984. link80015-0)
3 Carpenter RJ, Henley-Cohn JL, Snyder GG. Spastic dysphonia: treatment by selective section of the recurrent laryngeal nerve. The Laryngoscope 1979. link
4 Dedo HH. Recurrent laryngeal nerve section for spastic dysphonia. The Annals of otology, rhinology, and laryngology 1976. link