Contemporary management of spasmodic dysphonia.
OBJECTIVE
To review current concept in spasmodic dysphonia management.


RESULTS
The standard of care for spasmodic dysphonia in 2004 remains botulinum toxin chemodenervation for symptomatic management. This is supported by a large body of literature attesting to its efficacy in many different hands, particularly for the adductor form of the disorder. New surgical approaches await the crucial test of time, in view of historical difficulties in achieving long-term benefit via recurrent nerve section, and currently, surgery is best reserved for the rare patient who does not benefit or cannot tolerate botulinum toxin injections. Despite efforts to refine both surgical and botulinum toxin treatment, symptom relief in abductor spasmodic dysphonia and dystonia with tremor remains suboptimal.


CONCLUSIONS
Spasmodic dysphonia is a disorder of the central nervous system rather than the larynx, and as in other forms of dystonia, interventions at the end organ have not offered a definitive cure. The pathophysiology underlying dystonia is becoming better understood as a result of discoveries in genetically based forms of the disorder, and this approach is the most promising avenue to a long-term solution.
Sulica
Lucian
L
The Max Som, MD, Department of Otolaryngology, Beth Israel Medical Center, New York, New York, USA. lsulica@bethisraelny.org
D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D014827:Vocal Cords / Q000187:drug effects; D014832:Voice Disorders / Q000503:physiopathology / Q000628:therapy*
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins