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Abductor Spasmodic Dysphonia (ABSD)
Abductor spasmodic dysphonia is a disorder that effects thousands of people throughout the world. The disorder causes difficulty in speech and people who suffer with the disorder often have difficulty in social situations. The purpose of this discussion is to review the literature related to the treatment of abductor spasmodic dysphonia, specifically in the past 5-10 years.
Abductor spasmodic dysphonia
According to the National Institutes of Health Abductor spasmodic dysphonia (ABSD)is a type of voice disorder caused by involuntary movements of one or more muscles of the larynx or voice box. Individuals who have spasmodic dysphonia may have occasional difficulty saying a word or two or they may experience sufficient difficulty to interfere with communication. Spasmodic dysphonia causes the voice to break or to have a tight, strained or strangled quality (Spasmodic Dysphonia)."
The National Institutes of health also reports that the disorder is believed to be inherited and in some instances the disorder is psychogenic. According to Pittman et al. (2006) "Primary generalized dysphonia is clearly a genetic disorder and has been attributed to a defect on bands 9q32-34. The location of the genetic defect in patients with primary focal dysphonia is unknown (Pitmann et al. 2006)." In addition, most of the people who suffer from the disorder are between the ages of 30 and 50 years older (Spasmodic Dysphonia).
Although there is no cure for Abductor spasmodic dysphonia, there are several treatments that have been of great help to those that suffer from the disorder. Traditional treatments include voice therapy and surgery. Voice therapy is often used as a treatment for individuals who have a mild form of the disorder (Spasmodic Dysphonia). Surgery is also used as a treatment for the disorder. The surgery involves cutting one nerve on the folds of the vocal cord (Spasmodic Dysphonia). This is the recurrent laryngeal nerve. According to the National Institutes of Health this particular procedure usually provides temporary relief of the symptoms associated with the disorder. However, the relief provided by the surgery only last several years at the most and a few months at the least (Spasmodic Dysphonia). In addition another traditional treatment for the disorder is inclusive of psychological counseling. The counseling is designed to assists people with the disorder in living their lives with the disorder (Spasmodic Dysphonia).. It gives sufferers the coping skills they may need to seal with the disorder. For those with severe cases of the disorder some choose to get job counseling to assists them in choosing positions they can excel in even with speech limitations.
In addition to these traditional treatments, there are also newer treatments that have come to the forefront in recent years. One such treatment is Botulinum toxin (botox) injections. The injections are place into the muscles of the larynx that are effected by the disease. Botox can be beneficial with people with the disorder because it causes the muscles to weaken because it prevents the nerve impulse. According to the National Institutes of health this particular treatment last for three to four months. As with other types of botox treatments, the patient has to be reinjected with the botox to maintain the results. In addition there are side effects associated with the use of botox for the treatment of Abductor spasmodic dysphonia. These side effects include trouble swallowing, a weak voice, or a breathy voice.
Although some believe that this treatment is beneficial for Adductor Spasmodic dysphonia (ADSD), studies have also concluded that the use of botox to treat Abductor spasmodic dysphonia provides no benefit to those who suffer with the disorder. For instance an article entitled "Botulinum Toxin Therapy for Abductor
Botulinum toxin has been widely accepted as an effective therapy for controlling the symptoms of ADSD. In contrast, reported experience with botulinum treatment for ABSD has been variable and generally less impressive than for ADSD. Whereas botulinum toxin can substantially improve symptoms in nearly all ADSD patients, fewer ABSD patients obtain benefit, and the degree of improvement is less profound (Woodson et al., 2006)."
According to a study conducted by Blitzer et al., those ADSD patients receiving botox injections had an average benefit rate of 90%. On the other hand patients with ABSD receiving botox treatments only had an average benefit rate of 66% (Woodson et al., 2006).
In addition to the aforementioned studies Klein et al. (2008), recently found that more specific botox treatments such as bilateral posterior cricoarytenoid muscle botox injections can result in better outcomes.
According to Klein et al. (2008) in this particular study 37 people with ABSD were given botox injections in the bilateral posterior cricoarytenoid muscle. The study found that out of the 37 participants, 89% or 33 of the participants experienced improvements in their ABSD symptoms. The study also found that 3 participants experienced no improvement and 1 participant experienced a worsening of symptoms (Klein et al., 2008). This is evidence that botox treatments can be successful when they are administered in a fashion that targets the most affected areas. Like other treatments for ABSD botox treatments are temporary and will not cure the disorder. However many that suffer from ABSD have found it to be a positive and beneficial treatment.
In addition to botox treatment an alternative treatment known as medialization thermoplasty has also come to the forefront in recent years ("Laryngeal and Voice Disorders"). This particular treatment is a surgery in which an incision is made near the larynx and some of the thyroid cartilage is taken out ("Laryngeal and Voice Disorders").
Then a block of silicone or other material is secured to the cartilage ("Laryngeal and Voice Disorders"). According to the article the block becomes a shim that forces the vocal fold to the middle (medial). This works to improve vocal fold closure and improve speech in those with ABSD ("Laryngeal and Voice Disorders"). The author also explains that the surgery is fast and can take place under local anesthesia.
This particular surgery is not as well-known as the aforementioned surgery involving the cutting of the recurrent laryngeal nerve on the folds of the vocal cord. However it Is growing in popularity as a result of the relatively short recovery period and the ease with which the surgery can be performed. Although there has not been a great deal of research done regarding the outcomes of this surgery. It is quite likely that in the years to com research will begin to emerge about this particular surgery.
Another alternative treatment for the disorder is Acupuncture. According to Sulica (2004) the use of acupuncture as a treatment for spasmodic dysphonia has had ambiguous outcomes. According to the author
Eight weekly sessions in 10 subjects appeared to yield occasional improvement as judged by patients, but not by expert evaluators. Only four of 10 subjects were inclined to continue treatment, however. The report's vagueness regarding testing intervals and duration of benefit make comparison with established treatments nearly impossible (Sulica, 2004)."
Acupuncture isn't the only form of alternative therapy used to treat ABSD. Some people who suffer from the disorder have used hypnotism and electrical stimulation of the recurrent laryngeal nerve to treat ABSD ("SD"). None of these treatments have been studied enough to come to any conclusion regarding the outcomes of treatments. However, there is growing interests in the use of such treatments.
Overall the research seems to suggest that botox has become the most popular treatment for ABSD. In recent years more accurate types of injections of botox have made this treatment more effective. It seems that the popularity of botox has to do with the ease with which a patient can be injected with botox and the absence of recovery time. Additionally from some patients with severe forms of the disorder surgery has become a popular alternative. Although the surgery…[continue]
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