Spasmodic dysphonia: therapeutic options

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Abstract
Spasmodic dysphonia is a focal dystonia of the larynx. Most patients have the adductor variety characterized by a stereotypical strained and strangled voice quality. Intralaryngeal botulinum toxin (Botox) injection remains the mainstay of spasmodic dysphonia treatment. Botox, however, is limited by a short window of therapeutic effect and most patients need multiple injections each year. Some patients may additionally become resistant to the effects of Botox. Other chemotherapeutic agents are being sought to induce chemodenervation or chemomyectomy. Surgical treatment is also showing a resurgence after the initial trials in the 1970s and 1980s. Bilateral selective denervation of the laryngeal adductors with reinnervation by the ansa cervicalis holds promise for an excellent long-term treatment for adductor spasmodic dysphonia.