Differential diagnosis of muscle tension dysphonia and spasmodic dysphonia
ABSTRACT Muscle tension dysphonia (MTD) can mimic the voice features of adductor spasmodic dysphonia (ADSD) leading to diagnostic confusion. Researchers have begun to compare characteristics of MTD and ADSD to determine whether there are markers which reliably distinguish the two disorders and lead to improved differential diagnosis.
Differences between MTD and ADSD have been identified during fiberoptic laryngoscopy, phonatory airflow measurement, acoustic analysis, and variable sign expression based upon phonatory task. In general, evidence of task-dependent sign expression and intraword phonatory breaks should raise suspicion of ADSD over MTD. However, on the basis of conventional standards of diagnostic precision, no single diagnostic test currently exists that reliably distinguishes the two disorders.
Although perceptual voice evaluation remains the standard for differential diagnosis of ADSD and MTD, knowledge of factors that influence the severity of sign expression in ADSD is important to differential diagnosis. During clinical assessment, voice clinicians who use generic stimulus materials that do not control for specific phonetic environments or voice tasks may miss critical phenomenological features of ADSD.
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ABSTRACT: Laryngeal Focal Dystonia (LFD) leads to a type of voice with a strained and tense quality which has a neurological origin, affecting the social-emotional realms of the individuals, and their quality of life. Measure the voice-related quality of life of patients with Adductor LFD pre and post-treatment with Botox, injection followed by voice therapy, using the Voice-Related Quality of Life (V-RQOL). Prospective study. Adductor 11 female patients aged between 33 and 74 years with a diagnosis of Adductor LFD were evaluated. All patients underwent a neurological evaluation. Laryngoscopy was performed with both rigid and flexible endoscopes. Speech and Language evaluation followed the Evaluation of Voice Protocol, proposed by Behlau, Pontes (1995). The American V-RQOL measure was utilized. Statistical analysis demonstrated significant difference (p < 0.05). 81.8% of patients showed higher scores post-Botox, for the social-emotional and physical domain. In the overall V-RQOL scores 72.7% of patients showed greater scores post-treatment. There was an improvement in the quality of life for these patients post-treatment. The V-RQOL proved to be an efficient tool to measure the treatment outcomes of LFD pre and post botulinum toxin injection.Revue de laryngologie - otologie - rhinologie 01/2010; 131(1):39-44.
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ABSTRACT: Voice tremor is a feature of many neurological conditions. Historically, clinical evaluation of voice tremor has relied on auditory-perceptual evaluation. We review developments in understanding of voice tremor that advocate additional approaches (acoustic, fibreoptic nasolaryngoscopic examination) to evaluation and stress the contribution from multiple sites in the speech mechanism to perceived tremor. An isolated focus on the speech signal does not identify the source/s of tremor. Structures in the pharynx and larynx can be important sources of perceived voice tremor. In addition to a sustained vowel phonatory task for evaluation, fibreoptic nasolaryngoscopic examination is recommended to observe tremor behaviour in different anatomic sites using different speech tasks; acoustic analysis is recommended to quantify tremor and enhance understanding of underlying mechanisms. Tremor measures (rate, periodicity, magnitude of frequency and amplitude tremor) have proved useful in differentiating speakers with tremor from normal speakers. Differentiating between tremor aetiologies is proving more challenging. The investigation of a conceptual model of voice tremor to understand the effect that oscillations in different parts of the speech mechanism have on the speech signal is an important development in the field. A sustained phonatory vowel task with fibreoptic nasolaryngoscopic examination of pharyngeal and laryngeal musculature, supplemented by acoustic measures, is currently recommended for clinical identification, quantification and characterization of voice tremor.Current opinion in otolaryngology & head and neck surgery 04/2011; 19(3):155-9. DOI:10.1097/MOO.0b013e328345970c · 1.84 Impact Factor
- Movement Disorders 03/2012; 27(3):346-8. DOI:10.1002/mds.24055 · 5.68 Impact Factor