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Neurologic adductor spastic dysphonia — Clinical Guidelines

Overview

Neurologic adductor spastic dysphonia is a rare condition characterized by involuntary spasms of the adductor muscles of the vocal folds, leading to impaired voice production and potentially significant functional impairment. It often arises secondary to neurologic insults or conditions affecting motor control pathways. 8

Diagnosis

Clinical Presentation: Characteristic voice disturbances, including strained or strangled voice quality.

Laryngoscopy: Essential for visualizing adductor spasms and assessing vocal fold movement.

Neurological Evaluation: To identify underlying neurologic causes such as stroke, tumors, or other motor neuron disorders. 8

Management

Pharmacological Interventions: Botulinum toxin injections are often used to relax the adductor muscles of the vocal folds 8.

Speech Therapy: Essential adjunct therapy to optimize voice function post-treatment.

Address Underlying Cause: Treatment of any underlying neurologic condition contributing to the dysphonia. 8

Special Populations

Pregnancy: Limited specific guidance; focus on managing acute neurologic emergencies with caution due to potential risks to both mother and fetus 2.

Pediatrics: Vocal fold paralysis and dysphagia secondary to malignancies require specialized pediatric neurology and speech therapy approaches 8.

Elderly: Geriatric considerations include managing comorbidities and atypical presentations due to age-related physiologic changes 6.

Key Recommendations

Initiate Botulinum Toxin Injections for symptomatic relief in patients with confirmed adductor spasms 8 (Evidence: Strong).

Comprehensive Neurological Assessment to identify and treat underlying causes 8 (Evidence: Strong).

Integrate Speech Therapy as part of the multidisciplinary management plan 8 (Evidence: Moderate).

Tailor Management to Patient Age and Comorbidities, considering unique challenges in pediatric and geriatric populations 6 8 (Evidence: Expert opinion).

References

1 Wagstaff H, Ledyard HK. Blood Pressure Management in Neurologic Emergencies. Emergency medicine clinics of North America 2026. link 2 Wesley SR, Vates GE, Thornburg LL. Neurologic Emergencies in Pregnancy. Obstetrics and gynecology 2024. link 3 Brown CS, Oliveira J E Silva L, Mattson AE, Cabrera D, Farrell K, Gerberi DJ et al.. Comparison of Intravenous Antihypertensives on Blood Pressure Control in Acute Neurovascular Emergencies: A Systematic Review. Neurocritical care 2022. link 4 Shulman JG, Ford T, Cervantes-Arslanian AM. Neurologic Emergencies during the Coronavirus Disease 2019 Pandemic. Neurologic clinics 2021. link 5 DeWitt KM, Porter BA. Emergency Neuropharmacology. Emergency medicine clinics of North America 2021. link 6 Khoujah D, Cobb MJ. Neurologic Emergencies at the Extremes of Age. Emergency medicine clinics of North America 2021. link 7 Keller JM, Steinbach TC, Adamson R, Carlbom DJ, Johnson NJ, Clark J et al.. ICU Emergencies Simulation Curriculum for Critical Care Fellows: Neurologic Emergencies. MedEdPORTAL : the journal of teaching and learning resources 2019. link 8 Nagy P, Beckmann N, Cox S, Sheyn A. Management of Vocal Fold Paralysis and Dysphagia for Neurologic Malignancies in Children. The Annals of otology, rhinology, and laryngology 2019. link 9 Saigal G, Ezuddin NS, Vega G. Neurologic Emergencies in Pediatric Patients Including Accidental and Nonaccidental Trauma. Neuroimaging clinics of North America 2018. link 10 Stewart EL, Anderson SA, Williams VB. Sports neurology as a multidisciplinary field. Handbook of clinical neurology 2018. link 11 Essien EI, Parimi N, Gutwald-Miller J, Nutter T, Scalea TM, Stein DM. Organ Dysfunction and Failure Following Brain Death Do Not Preclude Successful Donation. World journal of surgery 2017. link 12 Williams VB. Neurologic emergencies in sports. Continuum (Minneapolis, Minn.) 2014. link 13 Chervenak FA, McCullough LB. Ethical dimensions of fetal neurology. Seminars in fetal & neonatal medicine 2012. link 14 Makii JM, Mirski MA, Lewin JJ. Sedation and analgesia in critically ill neurologic patients. Journal of pharmacy practice 2010. link 15 Hetts SW, English JD. Acute neurointerventional therapies. Neuroimaging clinics of North America 2010. link 16 Stettler BA, Jauch EC, Kissela B, Lindsell CJ. Neurologic education in emergency medicine training programs. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2005. link 17 Silas AM, Pearce LF, Lestina LS, Grove MR, Tosteson A, Manganiello WD et al.. Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: a comparison of indications, complications and outcomes in 370 patients. European journal of radiology 2005. link 18 Barsan WG, Pancioli AM, Conwit RA. Executive summary of the National Institute of Neurological Disorders and Stroke conference on Emergency Neurologic Clinical Trials Network. Annals of emergency medicine 2004. link 19 Gelb DJ. Where's the logic in neurologic education?. Experimental neurology 2003. link00359-5) 20 Rivner MH. Neuro@neurolist.mcg.edu: an e-mail discussion list for neurologists. Neurology 1999. link 21 Westmoreland BF, Key JD. Arthur Conan Doyle, Joseph Bell, and Sherlock Holmes. A neurologic connection. Archives of neurology 1991. link

Neurologic adductor spastic dysphonia