Arquivos Internacionais de Otorrinolaringologia 2010; 14(02): 163-166
DOI: 10.7162/S1809-48722010000200003
Original Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

Spasmodic Dysphonia: Description of the Disease and Associated Neurologic Disorders

Disfonia Espasmódica: Descrição da Doença e dos Distúrbios Neurológicos Associados
Marina Serrato Coelho
*   Resident Physician in the Department of Otorhinolaryngology, HC-UFPR.
,
Evaldo Macedo
**   Doctor. Physician in the Department of Otorhinolaryngology, HC-UFPR.
,
Marcela Schmidt Braz de Oliveira
***   Intern in the Department of Otorhinolaryngology, HC-UFPR.
,
Paulo Lobo
****   Physician.
,
Andréa Thomaz Soccol
*****   Otorhinolaryngologist.
,
Heloisa Nardi Koerner
*   Resident Physician in the Department of Otorhinolaryngology, HC-UFPR.
› Author Affiliations
Further Information

Publication History

01 October 2009

21 April 2010

Publication Date:
13 February 2014 (online)

Summary

Introduction: Spasmodic dysphonia (SD) is a problem that affects speech and vocalization, one of the most devastating disorders of oral communication. It is characterized by vocal quality tensaestrangulada, harshly and / or interspersed with abrupt vocal attack and a great tension in the vocal tract. The etiology of spasmodic dysphonia is unclear. Some authors point to psychogenic causes, neurological or even unknown.

Objective: To assess the prevalence of muscular dystonias and other neurological symptoms in patients with ED.

Method: A retrospective study of 10 cases with diagnosis of ED for symptoms and neurological disorders associated.

Results: There was a significant predominance of the disease in females (9:1). The average age of onset of symptoms was 32 years, ranging between 14 and 60 years. The mean disease duration was 10 years. Among the patients, 87.5% had a diagnosis of disorders of movement made by a neurologist, including orofacial dystonias (50%), essential tremor (50%) and spastic paraparesis (12%).

Conclusion: The presence of movement disorders followed almost all cases of spasmodic dysphonia. More studies are needed to clarify the pathophysiological basis of disease.

Resumo

Introdução: A disfonia espasmódica (DE) é um problema que afeta a fala e a vocalização, sendo uma das mais devastadoras desordens da comunicação oral. É caracterizada por qualidade vocal tensaestrangulada, áspera e/ou entrecortada, com ataque vocal brusco e grande tensão no aparelho fonador. A etiologia da disfonia espasmódica não é clara. Alguns autores apontam para causas psicogênicas, neurológicas ou até desconhecidas.

Objetivo: Avaliar a prevalência de distonias musculares e outros sintomas neurológicos nos pacientes com diagnóstico de disfonia espasmódica.

Método: Estudo retrospectivo de 10 casos com diagnóstico de disfonia espasmódica quanto a sintomas e desordens neurológicas associadas.

Resultados: Houve franca predominância da doença no sexo feminino (9:1). A idade média do início dos sintomas foi de 32 anos, variando entre 14 e 60 anos. O tempo médio de evolução da doença foi de 10 anos. Dos pacientes avaliados, 87,5% tinham diagnóstico de distúrbios do movimento feito por neurologista, entre eles distonias orofacias (50%), tremor essencial (50%) e paraparesia espástica (12%).

Conclusão: A presença de desordens do movimento acompanhou quase que a totalidade os casos de disfonia espasmódica. Mais estudos são necessários a fim de esclarecer a base fisiopatológica da doença.

 
  • Bibliographical References

  • 1 Klotz DA, Maronian NC, Waugh PF , et al. Findings of multiple muscle involvement in a study of 214 patients with laryngeal dystonia using fine-wire electromyography. Ann Otol Rhinol Laryngol 2004; 113 (8) 602-12
  • 2 Dias FMV , et al. Distonia primária e transtorno obsessivo-compulsivo. J Bras Psiquiat 2007; 56: 34-38
  • 3 Sulica L. Contemporary management of spasmodic dysphonia. Curr Opin Otolaryngol Head Neck Surg 2004; 12 (6) 543-8
  • 4 Ludlow CL, Adler CH, Berke GS , et al. Research priorities in spasmodic dysphonia. Otolaryngol Head Neck Surg 2008; 139 (4) 495-505
  • 5 Schweinfurth JM, Billante M, Courey MS. Risk factors and demographics in patients with spasmodic dysphonia. Laryngoscope 2002; 112 (2) 220-3
  • 6 Liu CY , et al. Emocional syntoms are secondary to the voice disorder in patients with spasmodic dysphonia. Gen Hosp Psychiatry 1998; 20 (4) 255-9
  • 7 Aminoff MJ, Dedo HH, Izdebski K. Clinical aspects of spasmodic dysphonia. J Neurol Neurosurg Psychiatry 1978; 41 (4) 361-5
  • 8 Dauer WT, Burke RE, Greene P , et al. Current concepts on the clinical features, etiology and management of idiopatic cervical dystonia. Brain 1998; 121: 547-560
  • 9 Behlau M. O Melhor que Vi e Ouvi atualização em laringe e voz. Revinter 1998; 88-97
  • 10 Kosaki H, Iwamura S, Yamazaki I. Histologic study of the recurrent laryngeal nerve in spasmodic dysphonia. Otolaryngol Head Neck Surg 1999; 120 (1) 129-33
  • 11 Murry T, Woodson GE. Combined-modality treatment of adductor spasmodic dysphonia with botulinum toxin and voice therapy. J Voice 1995; 9 (4) 460-5
  • 12 Blitzer A, Brin MF, Fahn S, Lovelace RE. Localized injections of botulinum toxin for the treatment of focal laryngeal dystonia (spastic dysphonia). Laryngoscope 1988; 98 (2) 193-7
  • 13 Cannito MP, Woodson GE, Murry T, Bender B. Perceptual analyses of spasmodic dysphonia before and after treatment. Arch Otolaryngol Head Neck Surg 2004; 130 (12) 1393-9
  • 14 Casserly P, Timon C. Botulinum toxin A injection under electromyographic guidance for treatment of spasmodic dysphonia. J Laryngol Otol 2008; 122 (1) 52-6
  • 15 Blitzer A, Brin MF, Stewart CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 1998; 108 (10) 1435-41
  • 16 Kimaid PA, Quagliato EM, Crespo NA , et al. Laryngeal electromyography in movement disorders: preliminary data. Arq Neuropsiquiatr 2004; 62 (3A): 741-4
  • 17 Larrosa F, Idígora A, Aguilar F, Riera L, Martí MJ, Valls J. Results of using botulism toxin in the treatment of spasmodic dysphonia. Acta Otorrinolaringol Esp 2002; 53 (1) 27-31
  • 18 Damrose JF, Goldman SN, Groessl EJ, Orloff LA. The impact of long-term botulinum toxin injections on symptom severity in patients with spasmodic dysphonia. J Voice 2004; 18 (3) 415-22
  • 19 Koufman JA, Rees CJ, Halum SL, Blalock D. Treatment of adductor-type spasmodic dysphonia by surgical myectomy: a preliminary report. Ann Otol Rhinol Laryngol 2006; 115 (2) 97-102
  • 20 Chan SW, Baxter M, Oates J, Yorston A. Long-term results of type II thyroplasty for adductor spasmodic dysphonia. Laryngoscope 2004; 114 (9) 1604-8
  • 21 Ludlow CL. Treatment for spasmodic dysphonia: limitations of current approaches. Curr Opin Otolaryngol Head Neck Surg 2009; 17 (3) 160-5