Movement Disorders and Voice

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Key points

  • The diagnosis of movement disorders affecting the voice should be made based on history and clinical findings.

  • Spasmodic dysphonia is a focal laryngeal dystonia where involuntary task-specific contractions of the laryngeal musculature affect the fluency of speech.

  • 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.

  • Botulinum toxin injections to affected muscles of the larynx

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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References (45)

  • J.M. Hintze et al.

    Spasmodic dysphonia: a review. part 2: characterization of pathophysiology

    Otolaryngol Head Neck Surg

    (2017)
  • C.L. Ludlow et al.

    Research priorities in spasmodic dysphonia

    Otolaryngol Head Neck Surg

    (2008)
  • D.N. Kirke et al.

    Alcohol responsiveness in laryngeal dystonia: a survey study

    J Neurol

    (2015)
  • C.L. Ludlow et al.

    Consensus-based attributes for identifying patients with spasmodic dysphonia and other voice disorders

    JAMA Otolaryngol Head Neck Surg

    (2018)
  • R.J. Stachler et al.

    Clinical practice guideline: hoarseness (dysphonia) (update) executive summary

    Otolaryngol Head Neck Surg

    (2018)
  • A.D. Hillel et al.

    Treatment of the interarytenoid muscle with botulinum toxin for laryngeal dystonia

    Ann Otol Rhinol Laryngol

    (2004)
  • C.G. Tang et al.

    Onabotulinum toxin A dosage trends over time for adductor spasmodic dysphonia: a 15-year experience

    Laryngoscope

    (2016)
  • A.F. Rumbach et al.

    An open-label study of sodium oxybate in Spasmodic dysphonia

    Laryngoscope

    (2017)
  • K. Dewan et al.

    Bilateral vocal fold medialization: a treatment for abductor spasmodic dysphonia

    J Voice

    (2017)
  • D.K. Chhetri et al.

    Long-term follow-up results of selective laryngeal adductor denervation-reinnervation surgery for adductor spasmodic dysphonia

    Laryngoscope

    (2006)
  • M.J. Pitman

    Treatment of spasmodic dysphonia with a neuromodulating electrical implant

    Laryngoscope

    (2014)
  • L. Sulica et al.

    Clinical characteristics of essential voice tremor: a study of 34 cases

    Laryngoscope

    (2010)
  • 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 Surgery
      Citation 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.

    • Classification, diagnosis and treatment of spasmodic dysphonia

      2022, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
    • How can we make better decisions about dystonic voice management?

      2021, Current Opinion in Otolaryngology and Head and Neck Surgery
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    Disclosure Statement: The authors have nothing to disclose.

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