Phonosurgery pp 163-174 | Cite as

Spastic Dysphonia

  • Nobuhiko Isshiki


Spastic dysphonia, first reported by Traube in 187120, has been controversial in every aspect—definition, etiology, symptoms, diagnostic basis, and treatment. The diagnosis is usually made auditorily on the basis of a strange strenuous manner of phonation. It has been described as strained, harsh, tight, strangulated, tremulous, squeezed voice, overpressure, vocal arrest, etc. Tentatively, it may be defined as dysphonia caused by spasm or excessive contraction of the intrinsic laryngeal muscle. It is often accompanied by spasm of the other muscles in the neck and oropharyngeal region.


Vocal Cord Recurrent Laryngeal Nerve Anterior Commissure Composite Graft Spasmodic Dysphonia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


20. Spastic Dysphoria

  1. Aminoff MJ, Dedo HH, Izdebski K (1978) Clinical aspects of spasmodic dysphonia. J Neurol Neurosurg Psychiatry 41: 361–365PubMedGoogle Scholar
  2. Arnold GE (1959) Spastic dysphonia. Logos 2: 3–14Google Scholar
  3. Aronson AE, Brown JR, Litin EM, Pearson JS (1968) Spastic dysphonia. 1 Voice, neurologic and psychiatric aspects. J Speech Hear Dis 33: 203–218Google Scholar
  4. Aronson AE, Brown JR, Litin EM, Pearson JS (1968) Spastic dysphonia II. Comparison with essential (voice) tremor and other neurologic and psychogenic dysphonias. J Speech Hear Dis 33: 219–231Google Scholar
  5. Aronson AE (1978) Differential diagnosis of organic and psychogenic voice disorders. In: Darley F, Spriestersbach DC (eds.) Diagnostic methods in speech pathology Harper & Row, New YorkGoogle Scholar
  6. Aronson AE (1980) Clinical voice disorders: an interdisciplinary approach. Thieme-Stratton, New York, pp 157–170Google Scholar
  7. Aronson AE, Hartman D (1981) Adductor spastic dysphonia as a sign of essential (voice) tremor. J Speech Hear Dis 46: 52–58Google Scholar
  8. Aronson AE, De Santo LW (1981) Adductor spastic dysphonia: \Vi years after recurrent laryngeal nerve resection. Ann Otol Rhinol Laryngol 90: 2–6PubMedGoogle Scholar
  9. Aronson AE, De Santo LW (1983) Adductor spastic dysphonia: three years after recurrent laryngeal nerve resection. Laryngoscope 93: 1–8PubMedGoogle Scholar
  10. Barton RT (1979) Treatment of spastic dysphonia by recurrent laryngeal nerve section. Laryngoscope 89: 244–249PubMedGoogle Scholar
  11. Berendes J (1939) Spastische Dysphonie. Arch Sprach Stimmheilk 3: 86–107Google Scholar
  12. Berendes J (1956) Neue Ergebnisse über Bewegungsstörungen des Kehlkopfes. Arch Ohr Nas Kehlk-heilk 169: 1–172Google Scholar
  13. Biller HF, Som ML, Lawson M (1979) Laryngeal nerve crush for spastic dysphonia. Ann Otol Rhinol Laryngol 88: 531–532PubMedGoogle Scholar
  14. Biller HF, Som ML, Lawson W (1983) Laryngeal nerve crush for spastic dysphonia. Ann Otol Rhinol Laryngol 92: 469PubMedGoogle Scholar
  15. Blitzer A (1985) Electromyographic findings in focal laryngeal dystonia (spastic dysphonia). Ann Otol Rhinol Laryngol 94: 591–594PubMedGoogle Scholar
  16. Blitzer A, Brin MF, Fahn S, Lange D, Lovelace RE (1986) Botulinum toxin (BOTOX) for the treatment of “spastic dysphonia” as part of a trial of toxin injections for the treatment of other cranial dystonias. Laryngoscope 96: 1300–1301PubMedGoogle Scholar
  17. Blitzer A, Brin MF, Fahn S, Lovelace RE (1988) Localized injections of botulinum toxin for the treatment of focal laryngeal dystonia (spastic dysphonia). Laryngoscope 98: 193–197PubMedGoogle Scholar
  18. Bloch CS, Hirano M, Gould WJ (1985) Symptom improvement of spastic dysphonia in response to phonatory tasks. Ann Otol Rhinol Laryngol 94: 51–54PubMedGoogle Scholar
  19. Bloch P (1965) Neuro-psychiatric aspects of spastic dysphonia. Folia Phoniatr 17: 301–364Google Scholar
  20. Bocchino JV, Tucker HM (1978) Recurrent laryngeal nerve pathology in spasmodic dysphonia. Laryngoscope 88: 1274–1278PubMedGoogle Scholar
  21. Boone D (1983) The voice and voice therapy. Prentice Hall, Englewood CliffsGoogle Scholar
  22. Brodnitz FS (1971) Voice rehabilitation, 4th ed. American Academy of ophtahlmology and Otolaryngology, RochesterGoogle Scholar
  23. Brodnitz FS (1976) Spastic dysphonia. Ann Otol Rhinol Laryngol 85: 210–214PubMedGoogle Scholar
  24. Cannito M, Johnson J (1981) Spastic dysphonia: A continuum disorder. J Commun Dis 14: 215–223Google Scholar
  25. Carlsoo B, Izdebski K, Dahlqvist A, Domeij S, Dedo HH (1987) The recurrent laryngeal nerve in spastic dysphonia. A light and electron microscopic study. Acta Otolaryngol 103: 96–104PubMedGoogle Scholar
  26. Carpenter RJ, Henley-Cohn JL, Snyder GG (1979) Spastic Dysphonia: treatment by selective section of the recurrent laryngeal nerve. Laryngoscope 89: 2000–2003PubMedGoogle Scholar
  27. Carpenter RJ, Snyder GG, Henley-Cohn JL (1981) Selective section of the recurrent laryngeal nerve for the treatment of spastic dysphonia: an experimental study and preliminary clinical report. Otolaryngol Head Neck Surg 89: 986–991PubMedGoogle Scholar
  28. Cooper M (1973) Modern techniques of vocal rehabilitation. Charles C Thomas, SpringfieldGoogle Scholar
  29. Critchley M (1939) Spastic dysphonia. Inspiratory Speech. Brain 62: 96–103Google Scholar
  30. Damsté PH (1977) Spastic dysphonia: untying or cutting the knot. Ann Otol Rhinol Laryngol 89: 129–184Google Scholar
  31. Dedo HH (1976) Recurrent laryngeal nerve section for spastic dysphonia. Ann Otol Rhinol Laryngol 85 : 451–459PubMedGoogle Scholar
  32. Dedo HH, Izdebski K, Townsend JJ (1977) Recurrent laryngeal nerve histopathology in spastic dysphonia. A preliminary study. Ann Otol Rhinol Laryngol 86: 806–812PubMedGoogle Scholar
  33. Dedo HH, Townsend JJ, Izdebski K (1978) Current evidence for the organic etiology of spastic dysphonia. Otolaryngol Head Neck Surg 86: 875–880Google Scholar
  34. Dedo HH, Shipp T (1980) Spastic dysphonia: a surgical and voice therapy treatment program. College-Hill Press, HoustonGoogle Scholar
  35. Dedo HH, Izdebski K (1981) Surgical treatment of spastic dysphonia. Contemp Surg 18: 75–90Google Scholar
  36. Dedo HH, Izdebski K (1983a) Problems with surgical (RLN section) treatment of spastic dysphonia. Laryngoscope 93: 268–271PubMedGoogle Scholar
  37. Dedo HH, Izdebski K (1983b) Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia. Laryngoscope 93: 9–16PubMedGoogle Scholar
  38. Dedo HH, Izdebski K (1984) Evaluation and treatment of recurrent spasticity after recurrent laryngeal nerve section: a preliminary report. Ann Otol Rhinol Laryngol 93: 343–345PubMedGoogle Scholar
  39. Faaborg-Andersen KL (1957) Electromyographic investigation of intrinsic laryngeal muscles in humans. Acta Physiol Scand [Suppl 140] 41: 1–149Google Scholar
  40. Fahn S, Jankovic J (1984) Practical management of dystonia. Neurol Clin 2: 555–569PubMedGoogle Scholar
  41. Fahn S, List T, Moscowitz C (1985) Double blind controlled study of botulinum toxin for blepharospasm. Neurology 35: 271–272Google Scholar
  42. Fox D (1969) Spastic dysphonia: a case presentation. J Speech Hear Dis 34: 275–279Google Scholar
  43. Freeman FJ, Cannito MP, Finitzo-Hieber T (1984) Classification of spastic dysphonia by perceptual-acoustic-visual means. In: Gates GA (ed) Spastic dysphonia: state of the art. Voice Foundation, New York, pp 5–19Google Scholar
  44. Friedman M, Toriumi DM, Grybauskas V, Applebaum EL (1987) Treatment of spastic dysphonia without nerve section. Ann Otol Rhinol Laryngol 96: 590–596PubMedGoogle Scholar
  45. Fritzell B, Feuer E, Haglund S, Knutsson E, Schiratzki H (1982) Experiences with recurrent laryngeal nerve section for spastic dysphonia. Folia Phoniatr 34: 160–167Google Scholar
  46. Gates GA (ed) (1984) Spastic dysphonia: state of the art. Voice Foundation, New YorkGoogle Scholar
  47. Gould WJ, Tanabe M (1975) The effects of anesthesia of the internal branch of the superior laryngeal nerve upon phonation: an aerodynamic study. Folia Phoniatr 27: 337–349Google Scholar
  48. Hall JW, Jerger J (1976) Acoustic reflex characteristics in spastic dysphonia. Arch Otolaryngol 102: 411–415PubMedGoogle Scholar
  49. Hartman DE, Aronson AE (1981) Clinical investigation of intermittent breathy dysphonia. J Speech Hear Dis 46: 428–432Google Scholar
  50. Hartman DE, Vishwanat B (1984) Spastic dysphonia and essential (voice) tremor treated with primidone. Arch Otolaryngol 110: 394–397PubMedGoogle Scholar
  51. Heaver L (1959) Spastic dysphonia: psychiatric considertions. Logos 2: 15–24Google Scholar
  52. Heaver L (1960) Spastic dysphonia. A psychosomatic voice disorder. In: Barbara DA (ed) Psychological and psychiatric aspects of speech and hearing. Charles C Thomas Springfield, ILGoogle Scholar
  53. Henschen TL, Burton NG (1978) Treatment of spastic dysphonia by EMG biofeedback. Biofeedback Self-regulation 3: 91–96PubMedGoogle Scholar
  54. Honjo I, Honda K, Takashima Y, Murakami Y (1977) Surgical treatment of spastic dysphonia. Pract Otol (Kyoto) 70: 319–322 (in Japanese)Google Scholar
  55. Horn KL, Dedo HH (1980) Surgical correction of the convex vocal cord. Laryngoscope 90: 281–286PubMedGoogle Scholar
  56. Isshiki N (1977a) Functional surgery of the larynx. Special Report, Jpn Soc Otorhiolayingol. ENT Alumni Association, Kyoto University, Kyoto (in Japanese)Google Scholar
  57. Isshiki N (1977b) Surgical Case problems in the professional voice, panel discussion. In: van Laurence L (ed) Transcripts of 6th Symposium on Care of the professional voice. Voice Foundation, New York, p 167Google Scholar
  58. Isshiki N (1980) Recent advances in phonosurgery. Folia Phoniatr 32: 119–154Google Scholar
  59. Iwamura S (1979) in: van Laurence L (ed) Spastic dysphonia: State of the art. Voice Foundation, New York, pp 26–32Google Scholar
  60. Iwamura S (1986) Selective section of a thyroarytenoid branch of the recurrent laryngeal nerve for spastic dysphonia and its long-term results. In: Proceedings of 20th Congress of IALP. Tokyo, pp 474–475Google Scholar
  61. Izdebski K, Shipp T, Dedo HH (1979) Predicting postoperative voice characteristics of spastic dysphonia patients. Otolaryngol Head Neck Surg 87: 428–434PubMedGoogle Scholar
  62. Izdebski K, Dedo HH (1980) Characteristics of vocal tremor in spastic dysphonia: a preliminary study. In: van Laurence L (ed) Transcripts of 8th Symposium on Care Professional Voice, part III. Voice Foundation, New York, pp 17–23Google Scholar
  63. Izdebski K, Dedo HH, Shipp T, Flower RM (1981) Postoperative follow-up studies on spastic dysphonia patients treated by recurrent laryngeal nerve section. Otolaryngol Head Neck Surg 89: 96–101PubMedGoogle Scholar
  64. Izdebski K, Dedo HH (1981a) Selecting the side of RLN section for spastic dysphonia. Otolaryngol Head Neck Surg 89: 423–426PubMedGoogle Scholar
  65. Izdebski K, Dedo HH (1981b) Spastic dysphonia. In: Darby JK Jr (ed) Speech evaluation in medicine. Grune and Stratton, New York, pp 105–127Google Scholar
  66. Izdebski K (1984) Overpressure and breathiness in spastic dysphonia. An acoustic (LTAS) and perceptual study. Acta Otolaryngol (Stockholm) 97: 373–378Google Scholar
  67. Izdebski K, Dedo HH, Boles L (1984) Spastic dysphonia: a patient profile of 200 cases. Am J Otolaryngol 5: 7–14PubMedGoogle Scholar
  68. Kao I, Drachman DB, Price DL (1976) Botulinum toxin: mechanism of presynaptic blockade. Science 193: 1256–1258PubMedGoogle Scholar
  69. Kiml J (1963) Le classement des aphonies spastiques. Folia Phoniatr 15: 269–277Google Scholar
  70. Kiml J (1965) Recherches expérimentales de la dysphonie spastique. Folia Phoniatr 17: 241–301Google Scholar
  71. Krumbach G (1987) Wie psychogen ist die spastische Dysphonie? Folia Phoniatr 39: 122–129Google Scholar
  72. Levine HL, Wood BG, Batza E, Rusnov M, Tucker HM (1979) Recurrent laryngeal nerve section for spasmodic dysphonia. Ann Otol Rhinol Laryngol 88: 527–530PubMedGoogle Scholar
  73. Ludlow CL, Naunton RF, Bassich CJ (1984) Procedures for the selection of spastic dysphonia patients for recurrent laryngeal nerve section. Otolaryngol Head Neclc Surg 92: 24–31Google Scholar
  74. Malmgren LT (1984) Neuromuscular anatomy of the larynx. In: Gates G A (ed) Spastic dysphonia, state of the art. Voice Foundation, New York, pp 33–38Google Scholar
  75. McCall GN, Skolnick ML, Brewer DW (1971) A preliminary report of some atypical movement patterns in the tongue, palate hypopharynx and larynx of patient with spasmodic dysphonia. J Speech Hear Dis 36: 466–470Google Scholar
  76. Moses PJ (1954) The Voice of Neurosis. Grune & Stratton, New YorkGoogle Scholar
  77. Parnes SM, Lavorato AS, Myers EN (1978) Study of spastic dysphonia using videofiber-optic laryngoscopy. Ann Otol Rhinol Laryngol 87: 322–326PubMedGoogle Scholar
  78. Pascher W (1982) Funkionelle Krankheiten der Stimme. In: Berendes, Link, Zöllner (eds) Hals-Nasen-Ohrenheilkunde. Thieme, StuttgartGoogle Scholar
  79. Perello J (1962) Dysphonies fonctionelles. Folia Phoniatr 14: 150–205Google Scholar
  80. Portnoy RA, Aronson AE (1982) Diadochokinetic syllable rate and regularity in normal and in spastic and ataxic dysarthric subjects. J Speech Hear Dis 47: 324–328Google Scholar
  81. Ravits JM, Aronson AE, DeSanto LW, Dyck PJ (1979) no morphometric abnormality of recurrent laryngeal nerve in spastic dysphonia. Neurology (Minneapolice) 29: 1376–1382Google Scholar
  82. Robe JE, Brumlik J, Moore P (1960) A study of spastic dysphonia: Neurologic and electroencephalographic abnormalities. Laryngoscope 70: 219–245PubMedGoogle Scholar
  83. Salassa JR, DeSanto LW, Aronson AE (1982) Respiratory distress after recurrent laryngeal nerve sectioning for adductor spastic dysphonia. Laryngoscope 92: 240–245PubMedGoogle Scholar
  84. Sanders I, Aviv J, Biller HF (1986) Transcutaneous electrical stimualtion of the recurrent laryngeal nerve: a method of controlling vocal cord position. Otolaryngol Head Neck Surg 95: 152–157PubMedGoogle Scholar
  85. Sapir S, Aronson AE (1985) Clinician reliability in rating voice improvement after laryngeal nerve section for spastic dysphonia. Laryngoscope 95: 200–202PubMedGoogle Scholar
  86. Sapir S, Aronson AE, Thomas JE (1986) Judgment of voice improvement after recurrent laryngeal nerve section for spastic dysphonia: clinicians versus patients. Ann Otol Rhinol Laryngol 95: 137–141PubMedGoogle Scholar
  87. Scott AB (1980) Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthamology 87: 1044–1049Google Scholar
  88. Segre R. (1951) Spasmodic dysphonia. Folia Phoniatr 3: 150–157Google Scholar
  89. Shipp T, Izdebski K, Reed C, Morrissey P (1985) Intrinsic laryngeal muscle activity in a spastic dysphonia patient. J Speech Hear Dis 50: 54–59Google Scholar
  90. Stoicheff ML (1983) The present status of adductor spastic dysphonia. J Otolaryngol 12: 311–314PubMedGoogle Scholar
  91. Taira T, Isshiki N, Harita Y, Ohkawa M (1983) Surgical treatment of spastic dysphonia Pract Otol (Kyoto) 76: 1887–1895 (in Japanese)Google Scholar
  92. Takayama E, Fukuda H, Kokawa N, Saito S (1988) A treatment of spastic dysphonia—selective resection of the terminal branch of the recurrent laryngeal nerve in the thyroarytenoid muscle. J Jpn Bronchoesophagol Soc 39: 275–278Google Scholar
  93. Traube L (1871) Spastische From der nervösen Heiserkeit. In: Gesammelte Beiträge zur Pathologie und Physiologie, vol 2 part 2. Hirschwald, Berlin, p 677Google Scholar
  94. van Lawrence L (ed) (1977) Transcript of the sixth symposium, care of the professional voice, the Julliard school, Voice Foundation, New York, p. 167Google Scholar
  95. van Lawrence L (ed) (1979) Spastic dysphonia: state of the art. Voice Foundation, New YorkGoogle Scholar
  96. Watanabe H, Komiyama S, Ryu S, Kannae D, Matsubara H (1982) Biofeedback therapy for spastic dysphonia. Auris Nasus Larynx 9: 183–190PubMedGoogle Scholar
  97. Watanabe H, Shin T, Oda M, Fukaura J, Komiyama S (1987) Measurement of total actual speaking time in a patient with spastic dysphonia. Folia Phoniatr 39: 65–70Google Scholar
  98. Wendler W, Seidner W (1977) Lehrbuch der Phoniatrie. VEB Georg Thieme, LeipzigGoogle Scholar
  99. White JF, Knight RE (1981) Recurrent laryngeal nerve section in the treatment of spastic dysphonia. South Med J 74: 1053–1055PubMedGoogle Scholar
  100. Wieser M (1981) Periodendaueranalyse bei spastischen Dysphonien. Folia Phoniatr 33: 314–324Google Scholar
  101. Wilson FB, Oldring DJ, Mueller K (1980) Recurrent nerve section: a case report involving return of spastic dysphonia after initial surgery. J Speech Hear Dis 45: 112–118Google Scholar
  102. Wolfe VI, Bacon M (1976) Spectrographic comparison of two types of spastic dysphonia. J Speech Hear Dis 41: 315–324Google Scholar
  103. Wolfe VI, Ratusnik DL, Feldman H (1979) Acoustic and perceptual comparison of chronic and incipient spastic dysphonia. Laryngoscope 89: 1478–1486PubMedGoogle Scholar

Copyright information

© Springer Japan 1989

Authors and Affiliations

  • Nobuhiko Isshiki
    • 1
  1. 1.Department of Plastic Surgery, School of MedicineKyoto UniversityJapan

Personalised recommendations