Is surgery advisable for abductor spasmodic dysphonia?

Question

Hello doctor,

I suffer from abductor spasmodic dysphonia diagnosed nearly 11 years ago and I have received Botox injections every three to four months since then. Generally, they did work over the years until the last two years or so outcomes have been very poor. The last Botox shots by GA (six units left side) were a month back and again not successful, leaving me with little or no phonation. Botox is the only treatment offered in my area. Over the years I have tried every possible cure like prolonged speech therapy, laryngeal massage, vocal exercises, transdermal microphone, hypnosis, occupational therapy, and psychotherapy. Nothing proved to be a success. Surgery is the only option at this stage. I have had discussions with various ENT doctors who say they can see the problem very clearly but it will be very difficult to resolve. Two of the consultants strongly suggest thyroplasty type 3. Another suggested arytenoid adduction or coagulation of the PCA muscle by radio frequency. I am asking you for independent advice as to which surgery is best to restore my voice at even a relatively acceptable level. I understand thyroplasty type 3 and arytenoid adduction but should I choose thyroplasty 3 over coagulation of PCA muscle by radio frequency? I look forward to hearing from you. I have got videostroboscopy done.

Answer 1

Hi,

Welcome to icliniq.com.

First of all, you have to know that among spasmodic dysphonias, abductor variety is the least common type. In this, your vocal cord is away from the other vocal cord and the muscle is in unrestricted contraction resulting in voiceless or breathy voice. So, the treatment is mainly directed to reduce the contractions or spasms of posterior cricoarytenoid muscle (PCA). This can be achieved by mainly two treatments. One is Botox injection and the other is surgical which is mainly nerve ablation. The main treatment is Botox. Each Botox lasts for approximately six to eight weeks. Last failed botox may be due to fibrosis of muscle due to repeated injections. You can once again repeat the injection. That may be the best option. Surgery in abductor spasm is rarely done and not in literature. Avoid surgery. The next thing you can do is voice therapy. All cases of abductor spasm may have nasal flaring. You can sit in front of the mirror, start with vowels and sentences and try to reduce nasal flaring by looking into mirror. By reducing nasal flare, your voice will gradually increase.