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Speech Pathology Unit, Human Motor Control Section, MNB, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, MD.
Adductor spasmodic dysphonia involves an overadduction of the vocal folds during speech causing uncontrolled voice and pitch breaks and slow, effortful speech. The disorder is resistant to speech therapy and often recurs following initial benefit from unilateral recurrent laryngeal nerve resection. Botulinum toxin injections into multiple sites of the thyroarytenoid muscle on one side were performed in 16 patients. Speech was recorded prior to injection and three times post-injection. Symptoms were measured by two examiners from speech spectrograms without knowledge of speaker identity or recording session. Significant (p 
0.03) reductions in pitch and voice breaks, phonatory aperiodicity, and sentence time occurred only when injections resulted in unilateral vocal fold paralysis. Symptoms returned with the restoration of vocal fold movement, 3 months later. Reduction in speed of swallowing without aspiration was reported in 80% of cases. Although speech volume was reduced, there were no instances of aphonia.
Address correspondence and reprint requests to Dr. Ludlow, Speech Pathology Unit, HMCS, MNB, Building 10, Room 5N226, National Institutes of Health, Bethesda, MD 20892.
Presented in part at the thirty-ninth annual meeting of the American Academy of Neurology, New York, NY, April 1987.
Received August 7, 1987. Accepted for publication in final form December 17, 1987.
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 R E Morton, J Hankinson, and J Nicholson Botulinum toxin for cerebral palsy; where are we now? Arch. Dis. Child., December 1, 2004; 89(12): 1133 - 1137. [Abstract] [Full Text] [PDF]
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 S. M. Zeitels and G. B. Healy Laryngology and Phonosurgery N. Engl. J. Med., August 28, 2003; 349(9): 882 - 892. [Full Text] [PDF]
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 C Ertekin, I Aydogdu, Y Secil, N Kiylioglu, S Tarlaci, and T Ozdemirkiran Oropharyngeal swallowing in craniocervical dystonia J. Neurol. Neurosurg. Psychiatry, October 1, 2002; 73(4): 406 - 411. [Abstract] [Full Text] [PDF]
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 N. Bhattacharyya and D. Tarsy Impact on Quality of Life of Botulinum Toxin Treatments for Spasmodic Dysphonia and Oromandibular Dystonia Arch Otolaryngol Head Neck Surg, April 1, 2001; 127(4): 389 - 392. [Abstract] [Full Text] [PDF]
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M. E. Smith and C. N. Ford Resistance to Botulinum Toxin Injections for Spasmodic Dysphonia Arch Otolaryngol Head Neck Surg, April 1, 2000; 126(4): 533 - 535. [Abstract] [Full Text] [PDF]
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C. H ADLER, B. W EDWARDS, and S. F BANSBERG Female predominance in spasmodic dysphonia J. Neurol. Neurosurg. Psychiatry, November 1, 1997; 63(5): 688 - 688. [Full Text]
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 C. L. Ludlow Treatment of Speech and Voice Disorders With Botulinum Toxin JAMA, November 28, 1990; 264(20): 2671 - 2675. [Abstract] [PDF]
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