EpistemisSpasmodic dysphonia
Specialty: Otolaryngology.
Why it occurs
- Focal laryngeal dystonia of neurological origin (dysfunction of the basal ganglia that selectively affects the adductor or abductor muscles of the vocal cords)
- Psychological stress or severe emotional trauma that triggers a psychogenic voice disorder with dystonic characteristics
- Parkinsonism or generalized dystonia in evolution with early manifestations in the laryngeal muscles
Initial workup
Laryngoscopy and dynamic stroboscopic nasofibrolaryngoscopy evaluating the larynx during the speech of phrases loaded with vowels or voiceless consonants to differentiate the subtype (adductor or abductor), direct laryngeal electromyography, and brain MRI aimed at evaluating the basal ganglia.
red flags
Stridulous dyspnea during speech or rest, severe progressive dysphagia with episodes of frequent choking on liquids, weakness in lingual or velopharyngeal motility, or fixed vocal cord paralysis visible on direct laryngoscopy.
Standard management
- Local injection of Botulinum Toxin type A in the target laryngeal muscles — thyroarytenoid muscle for the adductor variant, or posterior cricoarytenoid muscle for the abductor, performed under electromyographic or endoscopic control by a specialized otorhinolaryngologist; is the treatment of choice
- Adjuvant speech therapy
- Systemic anticholinergic drugs such as trihexyphenidyl (used in generalized dystonias under strict neurological control).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 3
- Treatment options
- 3