title: Combined modality treatment of adductor spasmodic dysphonia.
abstract: BACKGROUND
  The hallmark characteristic of adductor spasmodic dysphonia (ADSD) is irregular and uncontrollable spasms within the intrinsic laryngeal muscles, resulting in erratic disruption of normal voicing.
  
  
  METHODS
  Using a random assignment and the inclusion of a behavioral sham to determine the effect of voice therapy after initial botulinum toxin type A (BTX-A) injections for ADSD, this study examined duration of injection benefit, perceived vocal quality of life from the Voice-Related Quality of Life (V-RQOL) scale, acoustic measures of vocal instability, and perceptual ratings of voice quality. Measures of these variables were collected before initial injection; 3, 7, and 12 weeks postinjection; and immediately before reinjection. Thirty-one individuals with ADSD participated in this study. One-third received no further intervention after BTX-A injection, one-third received a standard 5-week course of voice therapy after BTX-A injection, and one-third received a 5-week course of sham voice therapy after BTX-A injection.
  
  
  CONCLUSIONS
  Significant effects were observed on perceived quality of life and acoustic variables for all participants, over time. Participants who received voice therapy after BTX-A injection did not experience longer injection effect duration or significantly greater improvements in V-RQOL or acoustic variables than participants in BTX-A only or BTX-A plus sham therapy groups. Additionally, perceptual ratings of voice quality improved for all participants in response to BTX-A injection. For participants in this investigation, undertaking voice therapy did not appear to exert significant beneficial effects on the variables of interest.
authors.affiliation: Sciences for Health Professions, Santa Fe College, Gainesville, Florida, USA. epearson@ufl.edu
authors.forename: Erin P
authors.initials: EP
authors.lastname: Silverman
authors.forename: Cynthia
authors.initials: C
authors.lastname: Garvan
authors.forename: Rahul
authors.initials: R
authors.lastname: Shrivastav
authors.forename: Christine M
authors.initials: CM
authors.lastname: Sapienza
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D013035:Spasm; D016896:Treatment Outcome; D014832:Voice Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D014833:Voice Quality / Q000187:drug effects / Q000502:physiology*; D014834:Voice Training; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A