A 35-year-old woman has a strained, strangulated, effortful voice with sound breaks, worst during conversation but absent when she sings or laughs. Laryngoscopy during speech shows hyperadduction of the true cords with a chink of opening. The most appropriate treatment is:

• A Botulinum toxin injection into the thyroarytenoid and lateral cricoarytenoid muscles ✓
• B Type I thyroplasty with medialisation implant
• C Voice rest followed by speech therapy alone as curative treatment
• D Bilateral posterior cordotomy

Explanation

This is adductor spasmodic dysphonia, a focal laryngeal dystonia characterised by a task-specific, effortful voice with breaks that vanish during singing or laughing. Botulinum toxin injected into the thyroarytenoid and lateral cricoarytenoid muscles under EMG guidance is the accepted standard of care, producing relief for several months per cycle. Type I thyroplasty corrects hypomobility, not hyperadduction, and posterior cordotomy would worsen glottic closure.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.