ADductor spasmodic dysphonia injection

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ADductor spasmodic dysphonia is the most common type of laryngeal dystonia and involves spasms of the muscles that close the vocal folds. It could be appropriately called the strain-strangled voice. The spasms cause a choking off of the voice or interruptions of the voice. Hear samples of ADductor spasmodic dyphonia. Adductor spasmodic dysphonia may also sound just like a tightness or effortfulness without any obivous cutting-out type symptoms.

What to expect from a Botox injection for ADductor spasmodic dysphonia

The initial wait

For a day or two your voice will usually be unchanged. Approximately 24-72 hours from the injection the spasms begin to diminish and the voice may be very good. Within a few hours the voice may become weak and breathy. Many wonder why this weakness develops. As the medicine begins to take effect, just a part of the muscle in the vocal folds is weak, while a short time later, when the injection has taken complete effect, most or all of the muscle will be weakened, thereby weakening your voice. In a few uncommon situations, the effect has come on over a week or two rather than right away. Some patients have noticed that if they rest their voice on the day of the injection, the medication works better. Conversely, if they have a lot of coughing on the day of the injection, it does not seem to take as well.

The "weak/breathy voice" phase

This phase lasts as little as a few days or as long as eight weeks. During this phase, you will notice that your voice is weak and cannot be heard in competition with background noise. You may find that you have to take a breath frequently when you talk, because you run out of air so quickly. A few people will also tend to cough on liquids, a side effect that tends to resolve faster than the breathy voice. If this swallowing problem happens to you, use extra care when drinking liquids, utilize thick liquids when possible, and try tucking your chin towards your chest when you drink. A product called "thick-it" is available to thicken liquids should this happen to you - 

Patients have used the following words to describe how they feel:

  • whispery
  • airy
  • helium voice
  • hilarious sounding cough
  • “Mickey Mouse” voice
  • I'm exhausted after I talk
  • My breathing seems harder (they are referring to the need to take frequent, deep breaths in order to keep up talking at a normal rate)
  • I feel a burning in my throat when I talk (the other normal muscles are working harder and getting achy)

The "talking is golden" phase

For one to three months after the "weak/breathy" phase has passed, the voice often seems virtually normal. Talking is a pleasure, and some forget they even have spasmodic dysphonia during this time.

The "spasms are back" phase

Typically, two to four months after your injection, just when the voice seems at its best, a spasm may occur. It may not be necessary to return to the office immediately for another injection, because you may still have several to many weeks of reasonable vocal function. As spasms become more noticeable, you should arrange another injection appointment.

Early laryngitis

Some persons experience what seems more like hoarseness rather than weakness during the first few days after an injection.

 

Technique

Unfortunately the precision of the injection is directly related to the outcome. What I have described above is based on my experience with the technique that I utilize. I frequently have patients who have been injected elsewhere with much larger doses and have very different responses in terms of side effects and durability of the injections. The overall dose does not really matter. What matters is how much gets into the specific muscle. Very low doses can be used when the injection is done precisely and accurately. See The art of an injection.