Bombay Hospital Voice and Swallowing Centre, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
Bombay Hospital Voice and Swallowing Centre, Bombay Hospital & Medical Research Centre, Mumbai, Maharashtra, India.
Am J Otolaryngol. 2021 May-Jun;42(3):102940. doi: 10.1016/j.amjoto.2021.102940. Epub 2021 Jan 28.
Spasmodic dysphonia (SD) is a neurological condition of the larynx characterised by task specific, involuntary spasms of the intrinsic laryngeal muscles causing frequent voice breaks during speech. The current treatment modality involves Botulinum Toxin injections into the affected group of muscles. This has yielded satisfactory results in Adductor SD (ADSD) and mixed SD but not in Abductor SD (ABSD). Sulcus vocalis is a morphological condition of the vocal folds with invagination of the superficial epithelium into the lamina propria or deeper layers. It is characterised by breathiness in voice and hypophonia. In our voice clinic, patients diagnosed with SD were occasionally found to have a sulcus on flexible stroboscopy. Studies have revealed an asymmetric stimulation of both the adductor and abductor group of muscles in ABSD and a predominant possibly symmetric stimulation of the adductor group of muscles in ADSD. Our objective was to study any significant association between vocal fold sulcus and two groups within SD; group one being ADSD and group two being both ABSD and Mixed SD. A literature review did not reveal any studies suggesting an association between SD and vocal fold sulcus to date.
A retrospective review of the stroboscopic video recordings as well as file records of all patients diagnosed with SD between January 2016 and September 2019 was conducted at our voice clinic. The first author was the laryngologist who had diagnosed SD and its type on the basis of hearing the voice and making the patient perform various vocal tasks with and without flexible videostroboscopy. The SD patients were divided into two groups with the first group consisting of ADSD patients and the second group consisting of ABSD as well as Mixed SD patients. The presence or absence of vocal fold sulcus was noted in all the SD patients. Odds ratio was used to establish statistical significance of the presence of vocal fold sulcus in the two SD groups.
Among the 106 patients of SD, 62 patients were males and 44 were females. A total of 84 patients were diagnosed as ADSD, 10 as ABSD and 12 as Mixed SD patients. Vocal fold sulcus was noted in 5 out of 84 patients of ADSD, 4 out of 10 patients of ABSD, and in 3 out of 12 patients of mixed SD. Odds Ratio of 7.37 (C.I. = 2.063-26.35) was obtained for the second group of patients i.e. ABSD and Mixed SD.
Our study revealed a significant association between patients of SD having an abductor component (ABSD and mixed SD) and vocal fold sulcus. The two hypothesis proposed for this are the possibility of asymmetrical adductor and abductor muscle stimulation in SD being responsible for the development of a vocal fold sulcus or the primary presence of a vocal fold sulcus contributing to altered sensory feedback resulting in SD. Further study to evaluate this, as well as a study of the vocal response to medialisation procedures for patients of ABSD with sulcus is recommended.
痉挛性发声障碍（SD）是一种喉部的神经学疾病，其特征是固有喉部肌肉的任务特异性、不自主痉挛，导致言语过程中频繁出现声音中断。目前的治疗方法是将肉毒杆菌毒素注射到受影响的肌肉群中。这种方法在内收性 SD（ADSD）和混合性 SD 中取得了满意的效果，但在外展性 SD（ABSD）中效果不佳。声带沟是声带的一种形态学状况，其特征是浅上皮向内层固有层或更深层凹陷。它的特征是声音有呼吸音和低调。在我们的语音诊所，偶尔会发现一些被诊断为 SD 的患者在柔性频闪喉镜下有沟状声带。研究表明，在 ABSD 中，内收肌和外展肌群都会受到不对称的刺激，而在 ADSD 中，内收肌群可能受到更对称的刺激。我们的目的是研究声带沟与 SD 中两组之间是否存在显著关联；第一组为 ADSD，第二组为 ABSD 和混合性 SD。文献综述显示，迄今为止，没有研究表明 SD 与声带沟之间存在关联。
对 2016 年 1 月至 2019 年 9 月期间在我们的语音诊所诊断为 SD 的所有患者的频闪喉镜录像和档案记录进行了回顾性分析。第一位作者是一位喉科医生，他根据听到的声音以及让患者在有无柔性视频频闪喉镜的情况下执行各种语音任务来诊断 SD 及其类型。SD 患者被分为两组，第一组为 ADSD 患者，第二组为 ABSD 和混合性 SD 患者。在所有 SD 患者中均记录声带沟的存在与否。使用比值比来确定声带沟在两组 SD 患者中的存在是否具有统计学意义。
在 106 例 SD 患者中，男性 62 例，女性 44 例。共有 84 例患者被诊断为 ADSD，10 例为 ABSD，12 例为混合性 SD 患者。在 84 例 ADSD 患者中有 5 例、10 例 ABSD 患者中有 4 例、12 例混合性 SD 患者中有 3 例出现声带沟。第二组患者（即 ABSD 和混合性 SD）的比值比为 7.37（C.I. = 2.063-26.35）。
我们的研究表明，SD 患者的外展肌成分（ABSD 和混合性 SD）与声带沟之间存在显著关联。为此提出了两个假设：SD 中内收肌和外展肌的不对称刺激可能导致声带沟的形成，或者声带沟的存在可能导致感觉反馈改变，从而导致 SD。建议进一步研究以评估这一点，以及研究 ABSD 患者中声带沟对中线化手术的反应。
