Faculty of Medicine, University of Toronto,Toronto, ON, Canada.
J Otolaryngol Head Neck Surg. 2010 Oct;39(5):622-30.
Adductor spasmodic dysphonia (ADSD) is a focal dystonia treated most commonly by chemodenervation of the thyroarytenoid (TA) muscles with botulinum toxin. Currently, there are no consensus guidelines regarding this treatment and the management of ADSD. The objective of this study was to assess current practice patterns among physicians who treat ADSD.
A cross-sectional survey study was conducted regarding treatment choices and specific technical aspects of injection technique and botulinum toxin use. The study population consisted of laryngologists from the Canadian Society of Otolaryngology-Head and Neck Surgery and laryngologists obtained from the American Laryngological Association member database and the American Academy of Otolaryngology-Head and Neck Surgery Neurolaryngology Study Group.
An overall response rate of 13% was achieved, with a high absolute number of physicians who manage ADSD responding (n = 37). Most respondents treat ADSD by injecting botulinum toxin type A (Botox) through the cricothyroid membrane submucosally at a mode starting dose of 2.5 units per TA muscle using electromyographic guidance with or without fibre-optic laryngoscopy every 3 to 4 months, with the frequency of reinjection being based on patient symptomatology. There is much variability with regard to starting injection dose, alternate treatments for ADSD, unilateral versus bilateral injections, and guidance technique. Most physicians (36 of 37) share one vial among more than one patient, and some (7 of 37) freeze a reconstituted vial that has remaining toxin for reuse at a later time.
There is considerable variability in treatment practices for the management of ADSD. Further study is warranted to define an optimal therapeutic paradigm.
内收肌痉挛性发音障碍（ADSD）是一种局灶性肌张力障碍，最常通过肉毒毒素化学去神经支配甲状软骨肌（TA）来治疗。目前，尚无关于这种治疗方法和 ADSD 管理的共识指南。本研究的目的是评估治疗 ADSD 的医生的当前实践模式。
对治疗选择以及注射技术和肉毒毒素使用的具体技术方面进行了横断面调查研究。研究人群包括加拿大耳鼻喉科学会的喉科医生以及从美国耳鼻喉科学会会员数据库和美国耳鼻喉科学会-头颈外科学会神经耳科学研究组获得的喉科医生。
实现了 13%的总体应答率，有相当数量的管理 ADSD 的医生做出了应答（n = 37）。大多数受访者通过经环甲膜粘膜下注射肉毒毒素 A 型（Botox）来治疗 ADSD，每块 TA 肌肉的起始剂量为 2.5 个单位，使用肌电图引导，或每 3 至 4 个月进行一次纤维喉镜检查，根据患者的症状进行再注射。在起始注射剂量、ADSD 的替代治疗、单侧与双侧注射以及引导技术方面存在很大的差异。大多数医生（37 名中的 36 名）会将一个小瓶分用于多个患者，一些医生（37 名中的 7 名）会将已配制的小瓶冷冻，以便以后在剩余毒素时再使用。
ADSD 管理的治疗实践存在相当大的差异。需要进一步的研究来定义最佳治疗模式。
