A 52-year-old woman has a strained, strangulated voice with effortful breaks in speech, but her voice is normal when laughing or singing. Fibreoptic laryngoscopy shows irregular hyperadduction of the vocal cords during connected speech. First-line treatment of choice is:

• A Unilateral vocal fold medialisation
• B Type III thyroplasty
• C CO2 laser cordectomy
• D Botulinum toxin injection into the thyroarytenoid muscles ✓

Explanation

Adductor spasmodic dysphonia is a focal dystonia with task-specific hyperadduction; voice normalises with non-speech tasks such as laughing. Botulinum toxin injected into the thyroarytenoid or lateral cricoarytenoid muscles produces chemodenervation and is the accepted first-line treatment, repeated every 3 to 4 months. Medialisation thyroplasty worsens adduction, cordectomy destroys tissue unnecessarily, and type III thyroplasty relaxes tension without addressing the dystonia.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.