Sanuki Tetsuji
Department of Otolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-Cho, Mizuho-Ku, Nagoya, Japan.
Auris Nasus Larynx. 2023 Feb;50(1):17-22. doi: 10.1016/j.anl.2022.05.012. Epub 2022 Jun 11.
Spasmodic dysphonia (SD) is considered a rare focal laryngeal dystonia characterized by task-specific voice dysfluency resulting from selective intrinsic laryngeal musculature hyperfunction. Symptoms may be attenuated by a sensory trick. Although SD can be seen at times in generalized dystonia syndrome, it is typically a sporadic phenomenon, and the involvement of the laryngeal adductor muscles is more common than that of the abductor muscles. This research reviews the literature for the pathogenesis, clinical characteristics, treatment options, and current management methods of SD. Technological advances have enabled clinicians to better understand the connection between laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have helped better understand the underlying mechanisms of this neurolaryngology disorder. Currently, the standard of care for SD is the symptomatic management of botulinum toxin (BT) chemodenervation. This is supported by a large body of literature attesting to its efficacy in many different research studies, particularly in the uncomplicated adductor form of the disorder. Efforts towards surgical treatment predate the development of BT treatment by a decade, but the long-term efficacy has not been proven and, further research is expected. Symptom relief in patients with abductor SD and dystonia with tremors after surgical and BT treatments and those in patients remains suboptimal.
痉挛性发声障碍(SD)被认为是一种罕见的局灶性喉肌张力障碍,其特征为因喉内肌选择性功能亢进导致的特定任务性语音不流畅。感觉技巧可能会减轻症状。虽然SD有时可见于全身性肌张力障碍综合征,但它通常是一种散发性现象,且喉内收肌受累比外展肌更常见。本研究回顾了关于SD的发病机制、临床特征、治疗选择及当前管理方法的文献。技术进步使临床医生能够更好地理解喉功能与功能障碍之间的联系。成像和基因检测技术的改进有助于更好地理解这种神经喉科疾病的潜在机制。目前,SD的标准治疗方法是肉毒杆菌毒素(BT)化学去神经支配的对症治疗。大量文献支持这一方法,证实其在许多不同研究中有效,尤其是在该疾病的单纯内收肌型中。手术治疗的尝试比BT治疗的发展早十年,但长期疗效尚未得到证实,仍需进一步研究。接受手术和BT治疗后,外展肌型SD和伴有震颤的肌张力障碍患者的症状缓解情况仍不理想。