title: Management of supraglottic squeeze in adductor spasmodic dysphonia: a new technique.
abstract: OBJECTIVE
  Spasmodic dysphonia is a disabling disorder of the voice characterized primarily by involuntary disruptions of phonation. Botulinum toxin injections of the thyroarytenoid muscles have been the treatment of choice for adductor spasmodic dysphonia (ADSD). We describe a new technique to address the problem of compensatory or supraglottic hyperadduction in some of these patients.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Four patients with ADSD with sphincteric supraglottic contraction were seen for evaluation of botulinum toxin injection. On fiberoptic exam, it was noted that they had type I hyperadduction of the true vocal cords with a significant type III, and/or type IV hyperadduction of the supraglottis. After standard management of the thyroarytenoid muscles, the strained/strangled voice continued. On fiberoptic exam it was noted that the vocal folds were weakened, but the supraglottic hyperfunction persisted. The patients were treated by speech therapists to unload their supraglottis without success. All patients then had their oblique portion of the lateral cricoarytenoid muscles injected with botulinum toxin A through a thyrohyoid approach. This was done in the office under electromyographic control.
  
  
  RESULTS
  On follow-up, all patients demonstrated improvement in the quality of their voices (as compared to thyroarytenoid injections alone).
  
  
  CONCLUSIONS
  We describe a new technique for injection of the supraglottic portion of the lateral cricoarytenoid muscles. We demonstrate this can be done safely and successfully in an office setting with electromyography control.
authors.affiliation: New York Center for Voice and Swallowing, Columbia University, New York, NY 10019, USA. meghayoung@aol.com
authors.forename: Nwanmegha
authors.initials: N
authors.lastname: Young
authors.forename: Andrew
authors.initials: A
authors.lastname: Blitzer
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004576:Electromyography; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014832:Voice Disorders / Q000188:drug therapy*; D014833:Voice Quality