title: Task-specific singing dystonia: vocal instability that technique cannot fix.
abstract: OBJECTIVE
  Singer's dystonia is a rare variation of focal laryngeal dystonia presenting only during specific tasks in the singing voice. It is underdiagnosed since it is commonly attributed to technique problems including increased muscle tension, register transition, or wobble. Singer's dystonia differs from technique-related issues in that it is task- and/or pitch-specific, reproducible and occurs independently from the previously mentioned technical issues.This case series compares and contrasts profiles of four patients with singer's dystonia to increase our knowledge of this disorder.
  
  
  METHODS
  This retrospective case series includes a detailed case history, results of singing evaluations from individual voice teachers, review of singing voice samples by a singing voice specialist, evaluation by a laryngologist with endoscopy and laryngeal electromyography (LEMG), and spectral analysis of the voice samples by a speech-language pathologist.
  
  
  RESULTS
  Results demonstrate the similarities and unique differences of individuals with singer's dystonia. Response to treatment and singing status varied from nearly complete relief of symptoms with botulinum toxin injections to minor relief of symptoms and discontinuation of singing.
  
  
  CONCLUSIONS
  The following are the conclusions from this case series: (1) singer's dystonia exists as a separate entity from technique issues, (2) singer's dystonia is consistent with other focal task-specific dystonias found in musicians, (3) correctly diagnosing singer's dystonia allows singer's access to medical treatment of dystonia and an opportunity to modify their singing repertoire to continue singing with the voice they have, and (4) diagnosis of singer's dystonia requires careful sequential multidisciplinary evaluation to isolate the instability and confirm dystonia by LEMG and spectral voice analysis.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina. Electronic address: halstead@musc.edu.
authors.forename: Lucinda A
authors.initials: LA
authors.lastname: Halstead
authors.affiliation: Department of Music, College of Charleston, Charleston, South Carolina.
authors.forename: Deanna M
authors.initials: DM
authors.lastname: McBroom
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina; Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Heather Shaw
authors.initials: HS
authors.lastname: Bonilha
mesh_terms: D000328:Adult; D000368:Aged; D004421:Dystonia; D020821:Dystonic Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D063346:Singing; D014832:Voice Disorders; D055815:Young Adult
keywords: Focal task–specific dystonia; LEMG; Musician's dystonia; Singers; Spasmodic dysphonia; Voice dystonia