A 45-year-old woman reports a strained, strangled, effortful voice that worsens with speech but is normal during laughing and whispering. Flexible laryngoscopy during phonation shows irregular hyperadduction of the true cords. The established first-line treatment is:
- A Botulinum toxin injection into the thyroarytenoid muscles ✓
- B Type I thyroplasty with medialisation implant
- C Systemic corticosteroids
- D CO2 laser cordectomy of both vocal cords
Correct answer: A. Botulinum toxin injection into the thyroarytenoid muscles
Explanation
Adductor spasmodic dysphonia is a focal laryngeal dystonia causing intermittent hyperadduction of the vocal cords during connected speech, while laughter and whispering remain unaffected because they are not voluntary phonation. Repeated botulinum toxin injections into the thyroarytenoid muscles weaken the spastic adduction and remain the gold standard treatment. Medialisation thyroplasty treats hypomobility, the opposite problem, and cordectomy would destroy the voice permanently.
Reference: Scott-Brown's Essential Otorhinolaryngology, 2nd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.