A 42-year-old woman reports her voice breaking intermittently in a strained, strangled manner, worse when speaking under stress, with a nearly normal singing voice. Stroboscopy shows intermittent hyperadduction of the true cords during connected speech. After failed speech therapy, what is the established next step in management?
- A Botulinum toxin injection into the thyroarytenoid and lateral cricoarytenoid muscles ✓
- B Type I thyroplasty with medialisation implant
- C Unilateral cordotomy via microlaryngoscopy
- D Injection laryngoplasty with autologous fat into Reinke's space
Correct answer: A. Botulinum toxin injection into the thyroarytenoid and lateral cricoarytenoid muscles
Explanation
Adductor spasmodic dysphonia is a focal dystonia causing task-specific hyperadduction of the cords during speech. The standard treatment after failed voice therapy is botulinum toxin injected percutaneously or through the cricothyroid membrane into the thyroarytenoid and lateral cricoarytenoid muscles, producing temporary paresis and smoother phonation for three to four months. Type I thyroplasty and fat injection treat glottal gap insufficiency, while cordotomy widens the airway in bilateral abductor palsy.
Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.