title: Endoscopic laser thyroarytenoid myoneurectomy in patients with adductor spasmodic dysphonia: a pilot study on long-term outcome on voice quality.
abstract: OBJECTIVE
  Adductor spasmodic dysphonia (ADSD) is a focal laryngeal dystonia, which compromises greatly the quality of life of the patients involved. It is a severe vocal disorder characterized by spasms of laryngeal muscles during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms result from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold to strain, pressing each vocal fold against the other and increasing glottic resistance. Botulinum toxin injection remains the gold-standard treatment. However, as injections should be repeated periodically leading to voice quality instability, a more definitive procedure would be desirable. In this pilot study we report the long-term vocal quality results of endoscopic laser thyroarytenoid myoneurectomy.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Surgery was performed in 15 patients (11 females and four males), aged between 29 and 73 years, diagnosed with ADSD. Voice Handicap Index (VHI) was obtained before and after surgery (median 31 months postoperatively).
  
  
  RESULTS
  A significant improvement in VHI was observed after surgery, as compared with baseline values (P=0.001). The median and interquartile range for preoperative VHI was 99 and 13, respectively and 24 and 42, for postoperative VHI. Subjective improvement of voice as assessed by the patients showed median improvement of 80%.
  
  
  CONCLUSIONS
  Because long-term follow-up showed significant improvement of voice quality, this innovative surgical technique seems a satisfactory alternative treatment of ADSD patients who seek a definite improvement of their condition.
authors.affiliation: Department of Otorhinolaryngology, University of São Paulo, School of Medicine, São Paulo, SP, Brazil. domingostsuji@terra.com.br
authors.forename: Domingos Hiroshi
authors.initials: DH
authors.lastname: Tsuji
authors.forename: Marystella Tomoe
authors.initials: MT
authors.lastname: Takahashi
authors.forename: Rui
authors.initials: R
authors.lastname: Imamura
authors.forename: Adriana
authors.initials: A
authors.lastname: Hachiya
authors.forename: Luiz Ubirajara
authors.initials: LU
authors.lastname: Sennes
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D055154:Dysphonia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007821:Laryngeal Muscles / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D007828:Laryngoscopy / Q000295:instrumentation; D053685:Laser Therapy / Q000295:instrumentation; D054020:Lasers, Gas; D008297:Male; D008875:Middle Aged; D009121:Muscle Denervation / Q000295:instrumentation; D010699:Phonation; D010865:Pilot Projects; D011446:Prospective Studies; D020127:Recovery of Function; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology / Q000601:surgery*; D013060:Speech; D013068:Speech Production Measurement; D013997:Time Factors; D016896:Treatment Outcome; D014833:Voice Quality