Pharyngeal Dystonia Mimicking Spasmodic Dysphonia

• Type of Material: Article
• Authors: Lucy L. Shi, Emory University; C. Blake Simpson, University of Texas San Antonio; Edie R. Hapner, Emory University; Hyder Jinnah, Emory University; Michael M. Johns, III, Emory University
• Language: English
• Date: 2018-03-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 The Voice Foundation
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jvoice.2017.05.004
• Title of Journal or Parent Work: Journal of Voice
• ISSN: 0892-1997
• Volume: 32
• Issue: 2
• Start Page: 234
• End Page: 238
• Grant/Funding Information: This work was supported in part by grant NS065701 from the Office of Rare Diseases Research in the National Center for Advancing Translational Sciences of the National Institutes of Health.
• Keywords: Dysphonia; Audiology & Speech-Language Pathology; Speech-language disorder; Segmental dystonia; Spasmodic dysphonia; Science & Technology; HALOPERIDOL; Otorhinolaryngology; Life Sciences & Biomedicine; Dystonia
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Speech Pathology

Abstract

Objective: The aim of this study was to describe the presentation of pharyngeal dystonia (PD), which can occur as a focal or segmental dystonia with a primarily pharyngeal involvement for the discussion of treatment methods for controlling consequent symptoms. PD is specific to speech-related tasks. Methods: A retrospective medical record review of four patients with PD was performed. Results: All patients were initially misdiagnosed with adductor spasmodic dysphonia and failed standard treatment with botulinum toxin type A (BTX). On laryngoscopy, the patients were discovered to have segmental or focal dystonia primarily affecting the pharyngeal musculature contributing to their vocal manifestations. A novel treatment regimen was designed, which involved directing BTX injections into the muscles involved in spasmodic valving at the oropharyngeal level. After titrating to an optimal dose, all patients showed improvement in their voice and speech with only mild dysphagia. These patients have maintained favorable results with repeat injections at 6- to 12-week intervals. Conclusions: PD, or dystonia with predominant pharyngeal involvement, is a rare entity with vocal manifestations that are not well described. It can be easily mistaken for spasmodic dysphonia. PD is specific to speech-related tasks. A novel method of BTX injections into the involved muscles results in a significant improvement in voice without significant dysphagia.