Bipolar radiofrequency-induced thermotherapy (rfitt) for the treatment of spasmodic dysphonia. A report of three cases.
The symptoms of adductor spasmodic dysphonia are most commonly palliated by periodic botulinum toxin injections. The need for repeated injections, difficulty in obtaining injections and cost make this form of treatment intolerable for some patients. To address these concerns, we propose a new treatment approach utilizing trans-oral recurrent nerve coagulation. The goal is to weaken the force of laryngeal closure during spasms by creating fibrosis of the terminal branches of one recurrent nerve through coagulation. Under general anesthesia without paralysis, an electrical stimulator is used to identify the region within the thyroarytenoid muscle that produces the greatest contraction with minimal stimulation. The radiofrequency laryngeal probe or electrocautery device is introduced into this position, and energy is delivered. The location of the region of maximal stimulation is usually just lateral and anterior to the vocal process of the arytenoids. Between 1989 and 2000, seven patients were treated with electrocautery. To achieve remission of spasms, three patients needed three sessions, four needed two sessions and one only one session. Since 2001, three patients have achieved remission of spasms with a single treatment with radiofrequency during which 80 J was delivered. Voice results are comparable to those obtained with botulinum toxin. Initially, the voice is breathy and laryngeal examination shows complete vocal fold immobility. After 1-2 months, the voice improves and examination reveals unilateral hypomobility. Trans-oral recurrent nerve coagulation is an effective alternative to botulinum toxin injections.
Remacle
Marc
M
Department of ENT and Head and Neck Surgery, University Hospital of Louvain at Mont-Godinne, Therasse avenue 1, 5530, Yvoir, Belgium. remacle@orlo.ucl.ac.be
Plouin-Gaudon
Isabelle
I
Lawson
Georges
G
Abitbol
Jean
J
D000328:Adult; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014827:Vocal Cords; D014832:Voice Disorders / Q000628:therapy*
Ann Otol Rhinol Laryngol. 1989 Jan;98(1 Pt 1):52-4
2910189
Neurology. 1979 Oct;29(10):1376-82
573382
Ann Otol Rhinol Laryngol. 1991 Feb;100(2):85-9
1992905
Adv Neurol. 1988;49:501-20
3278554
Laryngoscope. 1983 Mar;93(3):268-71
6834947
Laryngoscope. 1978 Aug;88(8 Pt 1):1274-8
209266
Ann Otol Rhinol Laryngol. 1976 Jul-Aug;85(4 Pt 1):451-9
949152
Otolaryngol Head Neck Surg. 1992 Nov;107(5):657-68
1437204
Otolaryngol Head Neck Surg. 1993 Mar;108(3):256-64
8464639
Otolaryngology. 1978 Nov-Dec;86(6 Pt 1):ORL-875-80
225708
Ann Otol Rhinol Laryngol. 1996 Aug;105(8):592-601
8712628
Ann Otol Rhinol Laryngol. 1999 Mar;108(3):227-31
10086613
Laryngoscope. 1986 Nov;96(11):1300-1
3773633
Otolaryngol Head Neck Surg. 1999 Jan;120(1):129-33
9914563
Ann Otol Rhinol Laryngol. 1979 Jul-Aug;88(4 Pt 1):531-2
475251