• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.1
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• pp.9-14
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• 2021

Spasmodic dysphonia, essential tremor, and vocal tremor related with Parkinson's disease are different disorders showing fairly similar symptoms such as difficulty in the speech onset, and tremble in the voice. However, the cause and the resulting treatment of these diseases are different. Spasmodic dysphonia is a vocal disorder characterized by spasms of the laryngeal muscles during a speech, invoking broken, tense, forced, and strangled voice patterns. Such difficult-to-treat dysphonia disease is classified as central-origin-focal dystonia, of a yet unknown etiology. Its symptoms arise because of intermittent and involuntary muscle contractions during speech. Essential tremor, on the other hand, is characterized by a rhythmic laryngeal movement, resulting in alterations of rhythmic pitch and loudness during speech or even at rest. Severe cases of tremor may cause speech breaks like those of adductor spasmodic dysphonia. In the case of hyper-functional tension of vocal folds and accompanying tremors, it is necessary to distinguish these disorders from muscular dysfunction. A diversified assessment through the performance of specific speech tasks and a thorough understanding for the identification of the disorder is necessary for accurate diagnosis and effective treatment of patients with vocal tremors.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.8 no.2
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• pp.199-203
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• 1997

In the treatment of spasmodic dysphonia, local injection of botulinum toxin A has been reported to be successful. The treatment of adductor type spasmodic dysphonia with botulinum toxin type A injection using a flexible nasopharyngoscope was conducted in 29 patients and using a telearyngoscope in 31 patients. These patients were given toxins in the vocal fold(s), unilaterally or bilaterally, under flexible nasopharyngoscopic guidance with sclerosing needle or telelaryngoscopic guidance with 23 gauge scalp needle attached by laryngeal forceps. Before the above procedure, laryngeal anesthesia was done with 2% pontocain instillation. Among the 60 patients, 59 patients were given the toxin successfully. Telephone interview were made at 2weeks and then at 4 weeks post injection. Among 29 patients using a flexible nasopharyngoscope, 75.8% and among 31 patients using a telelaryngoscope, 90.0% reported that the patients' symptom was improved. The functional status of the patient's disorder was classified into four grades. The mean pre-injection grade fir the patients using flexible nasopharyngoscope and telelaryngoscope was 1.6 and 2.1 respectively. And it was lowered to 0.7 and 1.1 respectively after the injection. The result was similar(p<0.05). As a self assessment method, the patients were asked to rate their voice on a scale of 100. In this study, the mean pre-injection score was 44 and 40 respectively. And it was improved to 77.7 and 69.8 respectively after the injection. The result was similar(p<0.05). In conclusion, botulinum toxin injection using a flexible nasopharyngoscope is also an effective method for the treatment of adductor type spasmodic dysphonia as using a telelaryngoscope.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.8 no.2
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• pp.204-209
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• 1997

In the treatment of spasmodic dysphonia, laryngeal injection of botulinum toxin has been reported to be successful. The treatment of adductor type spasmodic dysphonia with botulinum toxin type A injection using EMG was conducted in 24 patients and it's effect was compared with results from flexible nasopharyngoscopy guided injection(29 patients) and telelaryngoscopy guided injection(31 patients). Sixty two point five percent(62.5%) of patients using EMG and 75.8% of patients using flexible nasopharyngoscope and 90.0% of patients using telelaryngoscope reported that the patient's symptom was improved. The functional status of the patient's disorder was classified into low grades. The mean pre-injection grade for patients using EMG, flexible nasopharyngoscope and telelaryngoscope was 1.7, 1.6 and 2.1 respectively. And it was lowered to 1.0, 0.7 and 1.1 respectively after the injection. Results were similar(p＜0.05). As a self assessment method, patients were asked to rate their voice on a scale of 100. In this study, the mean pre-injection score was 66.3, 44.0 and 40.0 respectively. And it was improved to 74.8, 77.7 and 69.8 respectively after the injection. Among 23 patients who undergone above 3method, 17 patients(73.9%) told that EMG-guided botulinum injection was preferable method in its convenience and effectiveness. In conclusion, EMG guided botulinum toxin injection is an another effective method for the treatment of adductor type spasmodic dysphonia similar to telelaryngoscopy-guided injection and flexible nasopharyngoscopy guided injection.

• Proceedings of the KSLP Conference
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• 2014.03a
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• pp.27-27
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• 2014

• Phonetics and Speech Sciences
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• v.8 no.2
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• pp.73-80
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• 2016

The purpose of this study was to analyze perceptual and spectral/cepstral measurements in patients with adductor spasmodic dysphonia(ADSD). Sixty participants with gender and age matched individuals(30 ADSD and 30 controls) were recorded in reading a sentence and sustained the vowel /a/. Acoustic data were analyzed acoustically by measuring CPP, L/H ratio, mean CPP F0 and CSID, and auditory-perceptual ratings were measured using GRBAS. The main results can be summarized as below: (a) the CSID for the connected speech was significantly higher than for the sustained vowel (b) the G, R and S for the connected speech were significantly higher than for the sustained vowel (c) Spectral/cepstral parameters were significantly correlated with the perceptual parameters, and (d) the ROC analysis showed that the threshold of 13.491 for the CSID achieved a good classification for ADSD, with 86.7% sensitivity and 96.7% specificity. Spectral and cepstral analysis for the connected speech is especially meaningful on cases where perceptual analysis and clinical evaluation alone are insufficient.

• Speech Sciences
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• v.12 no.4
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• pp.203-213
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• 2005

This study was conducted to investigate the respiratory and aerodynamic function of adductor spasmodic dysphonia (ADSD) patients. Participants were (1) 18 females SD patients with non- Botulinum toxin injection (2) 14 females SD patients who had taken treatment of Botulinum toxin injection. (3) 14 age- and sex- matched normal female controls. Spirometer and phonatory function analyzer were used for respiratory muscle pressure (MIP: Maximum inspiratory pressure), MEP: Maximum expiratory pressure)& MPT(Maximum phonation time) and aerodynamic(F0:Fundamental frequency, intensity, MFR: Mean flow late, Psub: Subglottal pressure) measurement. The results were as follows: (1) Normal group was significantly higher in MIP, MEP, MPT than two SD groups (p < .05); (2) MPT was significantly lower in SD with non-Botulinum toxin injection group than SD with the treatment experience of Botulinum toxin injection (p < .05); (3) All aerodynamic parameters, F0, intensity, MFR, Psub, were not significantly different among three groups(p > .05).The reason of short MPT in ADSD may use lower respiratory pressure than normal group as strategy to decrease their tremulous voice quality. Moreover respiratory muscle pressure was lower than normal group regardless of botulinum toxin injection treatment.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.25 no.2
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• pp.79-81
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• 2014

Spasmodic dysphonia (SD) is a chronic, focal, speech-induced, action-specific dystonia, resulting strained voice. Muscle tension dysphonia (MTD) may also result in a strangled, strained voice quality, usually as a result of compensation for underlying laryngeal disease such as glottal insufficiency. Patients with SD and MTD were suffered from the severely limiting people's communication, especially via telephone and in noisy backgrounds. SD is usually of the adductor type characterized by glottic contractions causing tightness and voice breaks, which is difficult to distinguish from MTD. In this review article, we present the characteritics and management of SD and MTD.

• Phonetics and Speech Sciences
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• v.2 no.3
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• pp.157-164
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• 2010

This study investigated the characteristics of two aerodynamic indices, PTP (Phonation threshold pressure) and PTF (Phonation threshold flow) in patients with ADSD (adductor spasmodic dysphonia) and to see if two new aerodynamic indices can differentiate between normal and ADSD group. Additionally, PTP and PTF values were compared in terms of overall severity of ADSD in the patient group. The severity of ADSD was rated on a 7-point rating scale by two experienced speech language pathologists. The Kay Elemetrics Phonatory Aerodynamic System (PAS) (Kay Elemetrics Corp., Lincoln Park, NJ) was used to collect PTP and PTF measurements from 16 female normal subjects, 31 female patients with ADSD. Significantly lower PTF values (P< 0.05) were observed in ADSD when compared to those of normal control. Also, significantly lower PTF values in severe ADSD patients (P<.001). However, PTP could not distinguish patients with ADSD from control groups (P=0.119) and among the ADSD groups according to the severity (P=0.177). Consequently, PTF was more sensitive than PTP which might differentiate between normal speakers and ADSD and among different levels of severity within ADSD, suggesting that PTF could be a useful diagnostic parameter to measure the aerodynamic function of ADSD and provide the neurolaryngeal dysfunction in patients with ADSD.

• Phonetics and Speech Sciences
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• v.4 no.4
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• pp.95-107
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• 2012

As BTX-A, which has been known to be the most effective treatment for ADSD, is not effective in treating vocal tremors, voice assessment must be employed to perform differential diagnosis of SD and vocal tremor in an accurate fashion. In this study, the characteristics of vocal changes after botulinum toxin injection were compared by analyzing the voice characteristics resulting from the presence of vocal tremors using objective analysis devices, with the aim of helping to provide prognoses and to determine remedial effects in clinical cases comprising patients with adductor spasmodic dysphonia accompanied by voice tremors. Respiratory function tests, aerodynamic analysis, electroglottography (EGG), acoustic analysis, auditory perception tests, and K-VHI had been conducted at intervals of four, eight, and twelve weeks before and after injection, targeting a group of 17 ADSD female patients (a ADSD group of four with vocal tremor and a ADSD group of 13 without voice tremor). For average FVC and FEV1, the T group showed statistically significant low averages compared with the NT group, whereas the T group showed statistically significant high average ATRI compared with the NT group. In addition, the T group showed a statistically significant Fatr, lower than that of the NT group. For the ADSD group of patients with voice tremor, their vocal tremor remained unchanged despite noticeable decrease in wringing voices. In other words, as the vocal tremor and wringing voices are two distinctive features, there is a need for the two features to be targeted separately for differential diagnosis.

• The Journal of Internal Korean Medicine
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• v.44 no.2
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• pp.158-166
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• 2023

Background: Adductor spasmodic dysphonia (ASD) is caused by the involuntary contraction of laryngeal muscles due to dystonia localized to the larynx. In the case of ASD, conventional treatment is mainly performed with a botulinum toxin injection. However, the botulinum toxin injection has a short-lasting effect and requires repeated injections. Alternatives are needed due to concerns over adverse effects, such as general weakness and airway aspiration caused by the botulinum toxin injection. Case report: A 46-year-old female patient with ASD complained of voice tremor and hoarseness. The combined Korean medical treatments-Ukgan-san-gami, Jakyakgamcho-tang, acupuncture, and transcutaneous electrical nerve stimulation (TENS)-were administered on the first day the patient was hospitalized. The Voice Handicap Index (VHI) was evaluated during the treatment. The VHI taken on the second day totaled 92 points. On the ninth day, 81 points were recorded. Total score gradually improved, and on the 16th day, 62 points were recorded. Combined Korean medical treatment lasted 19 days. Conclusion: The present case report suggests that a combined Korean medical treatment approach with Ukgan-san-gami, Jakyakgamcho-tang, acupuncture, and TENS might be effective for symptoms such as voice tremors and hoarseness. Combined Korean medical treatment can be a therapeutic option for patients with ASD.