Ford C N, Bless D M, Lowery J D
Division of Otolaryngology, University of Wisconsin, Madison 53792.
Otolaryngol Head Neck Surg. 1990 Nov;103(5 ( Pt 1)):752-8. doi: 10.1177/019459989010300515.
Spasmodic dysphonia is a focal dystonia that causes a loss of the fine control of intrinsic laryngeal muscles and produces a strained staccato voice. Temporary relief from symptoms has been reported in patients treated with botulinum toxin percutaneously injected into the thyroarytenoid muscle. A newly developed method of treatment differs from reported methods by increasing the accuracy of botulinum toxin placement, reducing soft tissue trauma, and applying basic scientific information about the functional histology of intrinsic laryngeal musculature. Sixteen patients with primarily adductor spasmodic dysphonia were treated. Initial assessment included laryngeal examination by indirect laryngoscopy, videoendoscopy, and stroboscopy, neurology examination (including laryngeal EMG), and vocal function studies with acoustic analysis and aerodynamic studies. A device originally designed for collagen injection allowed the precise microdelivery of toxin to the thyroarytenoid muscle. Indirect laryngoscopy was used to direct the needle, in an attempt to cover a broad area of motor end plates. The minimally effective dose was titrated for each patient, to avoid paralysis and preserve laryngeal function. All patients showed improved voices after treatment. There were no major complications. The basic technique can be performed in the otolaryngologist's office and does not require electromyography equipment or expertise.
痉挛性发音障碍是一种局限性肌张力障碍，可导致喉内肌精细控制丧失，并产生紧张断续的嗓音。据报道，经皮向甲杓肌注射肉毒杆菌毒素治疗的患者症状可得到暂时缓解。一种新开发的治疗方法与已报道的方法不同，它提高了肉毒杆菌毒素注射的准确性，减少了软组织创伤，并应用了有关喉内肌功能组织学的基础科学信息。对16例主要为内收型痉挛性发音障碍的患者进行了治疗。初始评估包括间接喉镜检查、视频内镜检查和频闪喉镜检查进行喉部检查、神经学检查（包括喉肌电图）以及声学分析和空气动力学研究的嗓音功能研究。一种最初设计用于胶原蛋白注射的装置可将毒素精确微量注射到甲杓肌。使用间接喉镜引导针头，试图覆盖广泛的运动终板区域。为每位患者滴定最低有效剂量，以避免麻痹并保留喉功能。所有患者治疗后嗓音均有改善。无重大并发症。该基本技术可在耳鼻喉科医生办公室进行，不需要肌电图设备或专业知识。
