title: Surgery or botulinum toxin for adductor spasmodic dysphonia: a comparative study.
abstract: OBJECTIVE
  Currently, botulinum toxin (Botox) injection is the standard of treatment for adductor spasmodic dysphonia (ADSD). We sought to compare the outcome of selective laryngeal adductor denervation-reinnervation (SLAD-R) surgery for ADSD to that of Botox injections.
  
  
  METHODS
  Patient-oriented measures (VHI-10) and objective single-blinded gradings of digital voice recordings were utilized as outcome measures. The surgical cohort, recruited by retrospective patient selection, consisted of 77 patients with a mean follow-up time of 7.54 +/- 2.55 years (range, 2.2 to 14.2 years). The injection cohort, recruited prospectively, included 28 patients with a mean follow-up time of 46.37 +/- 5.51 days (range, 36 to 54 days).
  
  
  RESULTS
  As measured by the VHI-10, the surgical patients had significantly improved voice handicap outcome scores (mean, 14.4 +/- 13.6) as compared to the patients who had Botox injection (mean, 26.5 +/- 12.1; p = 0.001). Aside from VHI-10 item 2, the surgical group demonstrated significantly improved voice-related function on each VHI-10 component (p = 0.01). Within the injection subgroup, 88% agreed that Botox successfully treats their ADSD, yet only 63% agreed that Botox improves their speech consistently. Within the surgical subgroup, 82% would recommend this surgery to others, and 78% agreed that their voice was actually better after surgery than after Botox. Objective voice ratings demonstrated similar levels of breathiness and overall voice quality in the treatment subgroups.
  
  
  CONCLUSIONS
  When indicated, the SLAD-R surgery for ADSD demonstrates outcomes equal to or superior to those of the current standard of Botox injections.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095-1624, USA.
authors.forename: Abie H
authors.initials: AH
authors.lastname: Mendelsohn
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Berke
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D055154:Dysphonia / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D007821:Laryngeal Muscles / Q000187:drug effects / Q000294:innervation / Q000601:surgery; D007826:Laryngismus / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009121:Muscle Denervation; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D012189:Retrospective Studies; D016037:Single-Blind Method; D013060:Speech; D014833:Voice Quality
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A