Department of Otolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Laryngoscope. 2020 Mar;130(3):741-746. doi: 10.1002/lary.28105. Epub 2019 Jun 6.
OBJECTIVES/HYPOTHESIS: The current gold standard of therapy for adductor spasmodic dysphonia (AdSD) is injection of botulinum toxin A (BTX) in the adductor musculature. A surgical procedure could potentially offer more stable and long-lasting voice quality. In this study, we report the long-term results of endoscopic laser thyroarytenoid (TA) myoneurectomy versus BTX treatment in the same patients with AdSD.
Retrospective case series.
Between July 2013 and September 2016, a total of 22 patients with AdSD were included. Voice outcomes were measured using the Voice Handicap Index and a Likert-scale patient-reported voice questionnaire. Data were obtained for each patient at four time points: preoperatively with and without BTX and twice postoperatively at 3 months (short term) and 12 months (long term).
No statistically significant differences were found between voice outcome after BTX injection and the short- and long-term postoperative voice outcomes for the group as a whole. During postoperative follow-up, 10 of the 22 patients (45%) needed a second procedure after an average of 18 months (interquartile range, 13-22 months) due to recurrence of their original voice problem.
The TA myoneurectomy showed encouraging results, comparable to BTX after follow-up of 12 months for the group as a whole. However, after good results initially, voice deterioration was seen in 45% of the patients who all underwent a second procedure. These preliminary results provide important insights into the value of TA myoneurectomy as a potential definite treatment for a select group of patients with AdSD. Further research might explore long-term results after revision surgery.
4 Laryngoscope, 130:741-746, 2020.
目的/假设：目前治疗内收肌痉挛性发音障碍（AdSD）的金标准是在内收肌注射肉毒毒素 A（BTX）。手术可能会提供更稳定和持久的音质。在这项研究中，我们报告了内镜激光甲状软骨-杓状软骨（TA）肌神经切除术与 BTX 治疗同一 AdSD 患者的长期结果。
回顾性病例系列。
2013 年 7 月至 2016 年 9 月，共纳入 22 例 AdSD 患者。采用嗓音障碍指数和 Likert 量表患者报告嗓音问卷评估嗓音结果。为每位患者在四个时间点获取数据：术前 BTX 注射前和注射后，以及术后 3 个月（短期）和 12 个月（长期）。
总体而言，BTX 注射后和整个组的短期和长期术后嗓音结果之间未发现统计学显著差异。在术后随访期间，由于原始嗓音问题的复发，22 例患者中有 10 例（45%）在平均 18 个月（四分位距，13-22 个月）后需要进行第二次手术。
TA 肌神经切除术显示出令人鼓舞的结果，与整个组的 BTX 相比，随访 12 个月后结果相当。然而，在最初取得良好效果后，45%的患者出现了嗓音恶化，所有这些患者都进行了第二次手术。这些初步结果为 TA 肌神经切除术作为一组特定的 AdSD 患者的潜在确定性治疗提供了重要的见解。进一步的研究可能会探索再次手术后的长期结果。
4 级喉镜检查，130：741-746，2020 年。
