Laryngeal Dystonia: A Series with Botulinum Toxin Therapy

TLDR

Laryngeal dystonia is a syndrome of action‑induced, involuntary laryngeal muscle spasms, most commonly affecting adductor muscles and producing spastic dysphonia, with abductor involvement causing whispering dysphonia and rare paradoxical vocal‑cord motion. Over five years, the authors treated more than 200 patients with botulinum toxin (BOTOX), including those with adductor and abductor laryngeal dystonia. Patients experienced benefit within 24–72 h, with sustained improvement averaging four months and 90 % of normal function, and only mild adverse effects, establishing BOTOX as the preferred therapy.

Abstract

Laryngeal dystonia is a syndrome characterized by action-induced, involuntary spasms of the laryngeal muscles. Most patients have involvement of the adductor laryngeal muscles producing uncontrolled spasms during phonation, and a “strain-strangle” speech pattern commonly termed “spastic dysphonia.” Other patients have involvement of the abductor muscles producing “whispering dysphonia.” Rare patients have paradoxical vocal cord motion during respiration with adductor spasms on inspiration. Over the past 5 years we have used botulinum toxin (BOTOX) to treat more than 200 patients with laryngeal dystonia. This group includes patients with adductor involvement (phonatory dystonia, recurrent laryngeal nerve section failure, respiratory dystonia) and those with abductor involvement (whispering dystonia). Patients received benefit within 24 to 72 hours, with sustained improvement for 2 to 9 months with an average of 4 months. Patients improved to an average of 90% of normal function. Clinically significant adverse effects included extended breathy dysphonia and mild choking on fluids. BOTOX has become our treatment of choice for dystonic conditions of the larynx.