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The diagnosis of movement disorders affecting the voice should be made based on history and clinical findings.
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Spasmodic dysphonia is a focal laryngeal dystonia where involuntary task-specific contractions of the laryngeal musculature affect the fluency of speech.
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Essential voice tremor may occur as a manifestation of essential tremor or isolated to the voice, causing periodic, oscillatory movements of the larynx and the resonance tract.
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Botulinum toxin injections to affected muscles of the larynx
Movement Disorders and Voice
Section snippets
Key points
Laryngeal dystonia/spasmodic dysphonia
Laryngeal dystonia (LD) is characterized by task-specific involuntary contractions of laryngeal musculature. Most LDs are focal in that they affect only the larynx, but LD also can occur as part of segmental or generalized dystonia. SD is the most common form of LD and the terms are often used interchangeably. SD is a focal dystonia that affects the fluency of speech.2 The exact pathophysiology of SD remains unknown, but it is generally believed a disorder of the central nervous system. Loss of
Essential voice tremor
Essential voice tremor (EVT) is the manifestation of ET in the phonatory apparatus.19 ET is defined as a mixed kinetic (occurring with movement) and postural tremor, which is not task specific and occurs in the absence of other neurologic symptoms. EVT affects approximately 10% to 25% of patients with ET20 and results in a tremulous voice that persists across all vocal tasks.19 EVT also can occur as the sole or predominant manifestation of ET and is referred to as isolated vocal tremor.20
Parkinson disease
PD results from cell death of dopaminergic neurons in the substantia nigra of the basal ganglia.26 It affects approximately 1 million people in the United States. In a study of 200 successive idiopathic PD patients presenting to a movement disorders clinic, more than 70% had speech impairment when speech samples were assessed by trained raters.27
Summary
Movement disorders of the larynx can be diagnosed accurately when the phenomenology of each disorder is well understood, a thorough history is obtained, and the patient is carefully observed and examined. Treatment should be tailored to the specific voice disorder and to the needs of each patient.
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Cited by (8)
Diagnostic protocol for dysphonia
2023, Medicine (Spain)Sulcus vocalis in spasmodic dysphonia—A retrospective study
2021, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :ABSD comprises a majority of the remaining cases and presents with hypophonia and breathy breaks in speech which are prolongations of the voiceless consonants [4]. Rarer forms of SD include Mixed SD, where patients have features of both ADSD and ABSD; singer's SD, where patients only have symptoms during singing; and adductor breathing SD, where adductor spasms occur during breathing resulting in stridor [3]. SD is rare with the estimated incidence as low as 1 per 100,000 cases [5] with the exact pathophysiology not known.
The role of laboratory investigations in the classification of tremors
2023, Neurological SciencesClassification, diagnosis and treatment of spasmodic dysphonia
2022, Chinese Journal of Otorhinolaryngology Head and Neck SurgeryHow can we make better decisions about dystonic voice management?
2021, Current Opinion in Otolaryngology and Head and Neck SurgeryDyspnea Index: An upper airway obstruction instrument; translation and validation in Swedish
2021, Clinical Otolaryngology
Disclosure Statement: The authors have nothing to disclose.