Refractory Dysphonia Due to Isolated Cricothyroid Muscle Dystonia

Shannon Kraft, Jana Childes, Allen Hillel, Joshua Schindler

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To demonstrate the utility of electromyography (EMG) in the evaluation and management of treatment-resistant dysphonia. Method: We report a case of refractory dysphonia in which EMG was used to identify and treat isolated cricothyroid (CT) dystonia. Results: The patient, a healthy 43-year-old woman, presented with 9months of progressive hoarseness. Her symptoms were present across vocal tasks but were particularly bothersome while dictating. On presentation, her voice was rated grade 3, roughness 3, breathiness 1, asthenia 0, and strain 3 (G3R3B1A0S3). Videostroboscopy was remarkable for hyperfunction. Voice therapy was not beneficial despite appropriate effort. Microdirect laryngoscopy revealed no evidence of structural pathology. The patient was referred for EMG because of her normal examination and failure to improve with therapy. The CT muscle demonstrated an increased latency of 750ms in all vocal tasks. One month after CT injection with 3 units of botulinum toxin (BTX), her voice was improved. Perceptual voice evaluation was rated G1R1B0A0S1. Voice Handicap Index improved from 87 to35. Conclusions: In the absence of structural pathology, EMG can be a useful adjunct in the diagnosis of dysphonia that persists despite adequate trials of voice therapy. To our knowledge, this is the only report of laryngeal dystonia due to isolated CT dysfunction successfully treated with BTX.

Original languageEnglish (US)
JournalJournal of Voice
DOIs
StateAccepted/In press - 2015

Fingerprint

Laryngeal Muscles
Dysphonia
Dystonia
Electromyography
Botulinum Toxins
Pathology
Asthenia
Hoarseness
Laryngoscopy
Therapeutics
Injections

Keywords

  • Cricothyroid muscle
  • Laryngeal dystonia
  • Laryngeal electromyography
  • Spasmodic dysphonia

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Speech and Hearing
  • LPN and LVN

Cite this

Refractory Dysphonia Due to Isolated Cricothyroid Muscle Dystonia. / Kraft, Shannon; Childes, Jana; Hillel, Allen; Schindler, Joshua.

In: Journal of Voice, 2015.

Research output: Contribution to journalArticle

@article{574f5ec7e5c14ff1b3ddfe595dff69f7,
title = "Refractory Dysphonia Due to Isolated Cricothyroid Muscle Dystonia",
abstract = "Objective: To demonstrate the utility of electromyography (EMG) in the evaluation and management of treatment-resistant dysphonia. Method: We report a case of refractory dysphonia in which EMG was used to identify and treat isolated cricothyroid (CT) dystonia. Results: The patient, a healthy 43-year-old woman, presented with 9months of progressive hoarseness. Her symptoms were present across vocal tasks but were particularly bothersome while dictating. On presentation, her voice was rated grade 3, roughness 3, breathiness 1, asthenia 0, and strain 3 (G3R3B1A0S3). Videostroboscopy was remarkable for hyperfunction. Voice therapy was not beneficial despite appropriate effort. Microdirect laryngoscopy revealed no evidence of structural pathology. The patient was referred for EMG because of her normal examination and failure to improve with therapy. The CT muscle demonstrated an increased latency of 750ms in all vocal tasks. One month after CT injection with 3 units of botulinum toxin (BTX), her voice was improved. Perceptual voice evaluation was rated G1R1B0A0S1. Voice Handicap Index improved from 87 to35. Conclusions: In the absence of structural pathology, EMG can be a useful adjunct in the diagnosis of dysphonia that persists despite adequate trials of voice therapy. To our knowledge, this is the only report of laryngeal dystonia due to isolated CT dysfunction successfully treated with BTX.",
keywords = "Cricothyroid muscle, Laryngeal dystonia, Laryngeal electromyography, Spasmodic dysphonia",
author = "Shannon Kraft and Jana Childes and Allen Hillel and Joshua Schindler",
year = "2015",
doi = "10.1016/j.jvoice.2015.06.005",
language = "English (US)",
journal = "Journal of Voice",
issn = "0892-1997",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Refractory Dysphonia Due to Isolated Cricothyroid Muscle Dystonia

AU - Kraft, Shannon

AU - Childes, Jana

AU - Hillel, Allen

AU - Schindler, Joshua

PY - 2015

Y1 - 2015

N2 - Objective: To demonstrate the utility of electromyography (EMG) in the evaluation and management of treatment-resistant dysphonia. Method: We report a case of refractory dysphonia in which EMG was used to identify and treat isolated cricothyroid (CT) dystonia. Results: The patient, a healthy 43-year-old woman, presented with 9months of progressive hoarseness. Her symptoms were present across vocal tasks but were particularly bothersome while dictating. On presentation, her voice was rated grade 3, roughness 3, breathiness 1, asthenia 0, and strain 3 (G3R3B1A0S3). Videostroboscopy was remarkable for hyperfunction. Voice therapy was not beneficial despite appropriate effort. Microdirect laryngoscopy revealed no evidence of structural pathology. The patient was referred for EMG because of her normal examination and failure to improve with therapy. The CT muscle demonstrated an increased latency of 750ms in all vocal tasks. One month after CT injection with 3 units of botulinum toxin (BTX), her voice was improved. Perceptual voice evaluation was rated G1R1B0A0S1. Voice Handicap Index improved from 87 to35. Conclusions: In the absence of structural pathology, EMG can be a useful adjunct in the diagnosis of dysphonia that persists despite adequate trials of voice therapy. To our knowledge, this is the only report of laryngeal dystonia due to isolated CT dysfunction successfully treated with BTX.

AB - Objective: To demonstrate the utility of electromyography (EMG) in the evaluation and management of treatment-resistant dysphonia. Method: We report a case of refractory dysphonia in which EMG was used to identify and treat isolated cricothyroid (CT) dystonia. Results: The patient, a healthy 43-year-old woman, presented with 9months of progressive hoarseness. Her symptoms were present across vocal tasks but were particularly bothersome while dictating. On presentation, her voice was rated grade 3, roughness 3, breathiness 1, asthenia 0, and strain 3 (G3R3B1A0S3). Videostroboscopy was remarkable for hyperfunction. Voice therapy was not beneficial despite appropriate effort. Microdirect laryngoscopy revealed no evidence of structural pathology. The patient was referred for EMG because of her normal examination and failure to improve with therapy. The CT muscle demonstrated an increased latency of 750ms in all vocal tasks. One month after CT injection with 3 units of botulinum toxin (BTX), her voice was improved. Perceptual voice evaluation was rated G1R1B0A0S1. Voice Handicap Index improved from 87 to35. Conclusions: In the absence of structural pathology, EMG can be a useful adjunct in the diagnosis of dysphonia that persists despite adequate trials of voice therapy. To our knowledge, this is the only report of laryngeal dystonia due to isolated CT dysfunction successfully treated with BTX.

KW - Cricothyroid muscle

KW - Laryngeal dystonia

KW - Laryngeal electromyography

KW - Spasmodic dysphonia

UR - http://www.scopus.com/inward/record.url?scp=84938246514&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84938246514&partnerID=8YFLogxK

U2 - 10.1016/j.jvoice.2015.06.005

DO - 10.1016/j.jvoice.2015.06.005

M3 - Article

JO - Journal of Voice

JF - Journal of Voice

SN - 0892-1997

ER -