SPASMOTIC DYSPHONIA—-ORIGINALLY DESCRIBED BY DEDO===LARYNGEAL DYSTONIA, SPASTIC DYSPHONIA, SPASTIC APHONIA, MOGIPHONIA AND LARYNGEAL STUTTER
(A CENTRAL MOTOR PROCESSING DISORDER RESULTING IN AN IDIOPATHIC FOCAL DYSTONIA)—DYSTONIAS ARE HYPERFUNCTIONAL DISORDERS OF VOLITIONAL MUSCLES—TYPICALLY ACTION INDUCED
BIMODAL INCIDENCE—EARLY AROUND AGE 8 AND MORE COMMONLY LATE (AGE 42)
DYSTONIAS DIVIDED INTO FOCAL, SEGMENTAL(LIMB), OR GENERALIZED
OTHER EXAMPLES OF FOCAL DYSTONIAS (ONE BODY PART) = BLEPHAROSPASM, OROMANDIBULAR (MEIGE’S SYNDROME), TORICOLLIS (WRY NECK), AND WRITER’S CRAMP
SPASMOTIC LARYNGEAL DYSTONIA–OFTEN ASSOC WITH NECK TIGHTNESS
90% ADDUCTOR—THYROARYTENOID-VOCALIS MUSCLE COMPLEX
DIFFICULTY IN VOICE INITIATION
CHOPPY VOICE, STRAINED, STRANGLED PATTERN WITH PITCH BREAKS—GLOTTAL FRY—MUST DIFFERENTIAT FROM ESSENTIAL TREMOR (4-12 HZ DURING SPEECH AND RESPIRATION)—-35% HAVE ASSOC TREMOR, HAS DIFFICULTY WITH READING SENTENCES WITH VOICED CONSONANTS FOLLOWED BY VOWELS, INCREASED JITTER AND SHIMMER WITH A DECREASED SIGNAL TO NOISE RATIO
WORSE WITH STRESS
FEMALE > MALE
Rx: INJECT THROUGH THE SUP CRICOTHYROID MEMBRANE WITH A 27 GUAGE NEEDLE HOOKED TO AN AUDIBLE EMG MACHINE—-AIM AS HIGH AS YOU CAN AND A BIT LATERAL—-START WITH 5 UNITS OF BOTOX
(OTHER RESEARCHERS HAVE ADVOCATED AN INF THYROID CARTILAGE WINDOW AND RESECTION OF THE THYROARYTENOID BRANCH OF THE RLN)
WARN PTS ABOUT POST PROCEDURE BREATHINESS AND MICROASPIRATION—WORST AT 48-72 HOURS)
1 UNIT OF BOTOX = A MOUSE UNIT = THE AMOUNT NEEDED TO KILL 50% OF A GROUP OF FEMALE SWISS WEBSTER MICE WEIGHING BETWEEN 18-20 G
ACTS AT THE PRESYNAPSE BY PREVENTING THE CA DEP EXOCYTOSIS OF ACh
10% ABDUCTOR—-PCA MUSCLE
PTS HAVE A BREATHY STRANGLED WHISPER VOICE
MAY GET POSSIBLE SOB POST INJECTION
SURGICAL RESECTION OF THE RLN IS NO LONGER RECOMMENDED BECAUSE OF POOR LONG TERM RESULTS