Outcomes of botulinum toxin treatment for patients with spasmodic dysphonia

Background: Spasmodic dysphonia (SD) is a focal dystonia of the larynx. Alt hough individuals with SD have variable degrees of difficulty in everyday c ommunication and speaking, many report significant impairments. The impact of SD on the quality of life of people with the disorder has not been well measured. Objectives: To assess the impact of SD using a voice-specific, validated ou tcomes instrument, the Voice Handicap Index (VHI), and to evaluate the effe ct of botulinum toxin treatment on quality of life. Methods: The VHI measures 3 subscales (physical, functional, and emotional) of impact of a voice disorder as well as a total impact score. The VHI was completed by 30 consecutive patients with SD before receiving botulinum to xin injection and 2 to 4 weeks after injection. Pretreatment scores on the VHI were compared with posttreatment scores. Results: Pretreatment scores on the VHI showed significant impairment in al l 3 subscales (physical, 25.5; functional, 21.4; and emotional, 20.4) and t he total score (67.6). Statistically significant improvements occurred in a ll 3 subscale scores and the total score (P=.001) for the 22 patients who c ompleted the posttreatment survey. Conclusions: Spasmodic dysphonia has a significant impact on patients' perc eption of quality of life as measured by the VHI. Significant improvements in all 3 subscale scores and the total score on the VHI occur after treatme nt with botulinum toxin.