Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.
J Voice. 2011 Jan;25(1):114-9. doi: 10.1016/j.jvoice.2009.08.003. Epub 2010 Feb 4.
OBJECTIVES/HYPOTHESIS: Up to one-third of patients presenting with adductor spasmodic dysphonia will have an associated vocal tremor. These patients may not respond fully to treatment using thyroarytenoid (TA) muscle botulinum toxin (Botox) injection. Treatment failures are attributed to the involvement of multiple muscle groups in the tremor. This study evaluates the results of combined interarytenoid (IA) and TA muscle Botox injection in a group of 27 patients with adductor spasmodic dysphonia and vocal tremor and in four patients with severe vocal tremor alone.
Patient-satisfaction data were reviewed retrospectively. Pre- and postinjection acoustic data were collected prospectively.
Acoustic measures of fundamental frequency and cycle-by-cycle variability in frequency (jitter) and intensity (shimmer) were obtained from 15 patients' sustained vowel productions. Measures were collected after TA muscle injection, alone, and after combined TA and IA (TA+IA) muscle injections. In addition, two experienced voice clinicians blindly assessed tremor severity from recordings made for each patient in the two conditions. Patients were also queried regarding their satisfaction with the results of the injections and whether they desired to continue receiving TA+IA treatment.
Significant improvement in all acoustic measures except for % jitter was observed after the TA+IA muscle injections. Listeners identified voice samples after TA+IA muscle injections as demonstrating less tremor in 73% of the paired comparisons. Sixty-seven percent of the patients with spasmodic dysphonia and vocal tremor wished to continue to receive IA muscle injections. Only one patient with severe vocal tremor wished to continue with injections.
The addition of an IA muscle Botox injection to the treatment of patients with a combination adductor spasmodic dysphonia and vocal tremor may improve voice outcomes.
目的/假设：多达三分之一出现内收痉挛性发音障碍的患者会伴有声音震颤。这些患者可能无法完全通过注射甲状软骨肌肉毒毒素（肉毒杆菌毒素）治疗来充分缓解症状。治疗失败归因于震颤涉及多个肌肉群。本研究评估了在 27 例内收痉挛性发音障碍伴声音震颤的患者和 4 例严重单纯性声音震颤的患者中，联合使用内收肌（IA）和甲状软骨肌（TA）肉毒毒素注射的效果。
回顾性审查患者满意度数据。前瞻性收集注射前和注射后的声学数据。
从 15 名患者的持续元音发音中获得基频和频率逐周期变化的声学测量值（抖动）和强度逐周期变化（颤抖）。在单独注射 TA 肌肉后，以及在联合注射 TA 和 IA（TA+IA）肌肉后，收集测量值。此外，两名经验丰富的语音临床医生在两种情况下对每位患者的录音进行盲法评估，以评估震颤严重程度。患者还被询问他们对注射结果的满意度，以及他们是否希望继续接受 TA+IA 治疗。
在注射 TA+IA 肌肉后，除了 %抖动之外，所有声学测量值均显著改善。在 73%的配对比较中，听众认为注射 TA+IA 肌肉后声音样本的震颤更轻。67%的痉挛性发音障碍伴声音震颤患者希望继续接受 IA 肌肉注射。只有 1 例严重声音震颤的患者希望继续接受注射治疗。
在患有内收痉挛性发音障碍和声音震颤的患者的治疗中，增加 IA 肌肉肉毒毒素注射可能会改善语音效果。
