Halstead Lucinda A, McBroom Deanna M, Bonilha Heather Shaw
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.
Department of Music, College of Charleston, Charleston, South Carolina.
J Voice. 2015 Jan;29(1):71-8. doi: 10.1016/j.jvoice.2014.04.011. Epub 2014 Jul 5.
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.
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 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.
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.
辛格氏肌张力障碍是局灶性喉肌张力障碍的一种罕见变异型，仅在歌唱时的特定任务中出现。由于它通常被归因于技术问题，包括肌肉紧张增加、声区转换或颤音，因此诊断不足。辛格氏肌张力障碍与技术相关问题的不同之处在于，它是任务和/或音高特异性的、可重复的，并且独立于上述技术问题而发生。本病例系列比较并对比了四名辛格氏肌张力障碍患者的情况，以增加我们对这种疾病的了解。
这个回顾性病例系列包括详细的病史、个体声乐教师的歌唱评估结果、一位歌唱专家对歌唱样本的评估、一位耳鼻喉科医生通过内窥镜检查和喉肌电图（LEMG）进行的评估，以及一位言语病理学家对语音样本的频谱分析。
结果显示了辛格氏肌张力障碍患者的相似性和独特差异。治疗反应和歌唱状态各不相同，从肉毒杆菌毒素注射几乎完全缓解症状到症状轻微缓解以及停止歌唱。
本病例系列得出以下结论：（1）辛格氏肌张力障碍作为一种与技术问题不同的独立病症存在；（2）辛格氏肌张力障碍与在音乐家身上发现的其他局灶性任务特异性肌张力障碍一致；（3）正确诊断辛格氏肌张力障碍能使患者获得肌张力障碍的医学治疗，并有可能调整其歌唱曲目，以便继续用现有嗓音歌唱；（4）辛格氏肌张力障碍的诊断需要仔细的多学科序贯评估，以通过LEMG和嗓音频谱分析来确定不稳定性并确诊肌张力障碍。
