COMBINED-MODALITY TREATMENT OF ADDUCTOR SPASMODIC DYSPHONIA WITH BOTULINUM TOXIN AND VOICE THERAPY

A combined-modality treatment program consisting of botulinum toxin in jection (Botox) and voice therapy was used to treat 17 subjects diagno sed with adductor spasmodic dysphonia (ADD SD). Ten subjects with ADD SD served as the control and were given Botox only. Voice therapy afte r Botox injection was directed toward reducing the hyperfunctional voc al behaviors, primarily glottal overpressure at voice onset and anteri or-posterior squeezing. The results indicated that subjects who underw ent combined-modality treatment maintained significantly higher mean a irflow rates for significantly longer periods. Moreover, there was a c arryover effect in these patients when they received Botox only. Adduc tor spasmodic dysphonia is treated most effectively when intrinsic lar yngeal muscle spasms are reduced or eliminated by Botox injection and extrinsic hyperfunctional vocal behaviors are treated with voice thera py.