ABSTRACT
OBJECTIVES: Vocal tremors, which cause social difficulties for patients, may be classified as resting or action tremors. Of the vocal action tremors, essential and dystonic tremors are the most common. Botulinum toxin and oral medications have been used to treat vocal tremors, but no comparative clinical trials have been performed. The aim of this study was to compare the effects of botulinum toxin injection and the oral administration of propranolol in the treatment of essential and dystonic vocal tremors. METHODS: This clinical trial recruited 15 patients, divided into essential and dystonic vocal tremor groups. Patients in both groups received successive treatment with botulinum toxin and propranolol. The treatments were administered at different times; the order of treatment was randomly selected. Patients were assessed with flexible nasofibrolaryngoscopy and with perceptual and acoustic voice evaluations. A statistical significance level of 0.05 (5%) was used. RESULTS: Botulinum toxin produced statistically significant improvements in perceptual measures of vocal instability in patients with dystonic vocal tremors compared with baseline values and treatment with propranolol. The acoustic measure of variability in the fundamental frequency was significantly lower in patients with dystonic vocal tremors after treatment with botulinum toxin. CONCLUSION: Essential and dystonic vocal tremors responded differently to treatment. Dystonic vocal tremors responded significantly to treatment with botulinum toxin but not oral propranolol. Essential vocal tremors did not respond significantly to either treatment, perhaps due to the small number of patients, which is a limitation of this research.
Subject(s)
Adrenergic beta-Antagonists/administration & dosage , Botulinum Toxins, Type A/therapeutic use , Dystonic Disorders/drug therapy , Laryngeal Muscles/drug effects , Neuromuscular Agents/administration & dosage , Propranolol/administration & dosage , Voice Disorders/drug therapy , Electromyography , Humans , Injections, Intramuscular , Propranolol/therapeutic use , Reproducibility of Results , Statistics, Nonparametric , Treatment Outcome , Tremor/drug therapyABSTRACT
OBJECTIVES: Vocal tremors, which cause social difficulties for patients, may be classified as resting or action tremors. Of the vocal action tremors, essential and dystonic tremors are the most common. Botulinum toxin and oral medications have been used to treat vocal tremors, but no comparative clinical trials have been performed. The aim of this study was to compare the effects of botulinum toxin injection and the oral administration of propranolol in the treatment of essential and dystonic vocal tremors. METHODS: This clinical trial recruited 15 patients, divided into essential and dystonic vocal tremor groups. Patients in both groups received successive treatment with botulinum toxin and propranolol. The treatments were administered at different times; the order of treatment was randomly selected. Patients were assessed with flexible nasofibrolaryngoscopy and with perceptual and acoustic voice evaluations. A statistical significance level of 0.05 (5%) was used. RESULTS: Botulinum toxin produced statistically significant improvements in perceptual measures of vocal instability in patients with dystonic vocal tremors compared with baseline values and treatment with propranolol. The acoustic measure of variability in the fundamental frequency was significantly lower in patients with dystonic vocal tremors after treatment with botulinum toxin. CONCLUSION: Essential and dystonic vocal tremors responded differently to treatment. Dystonic vocal tremors responded significantly to treatment with botulinum toxin but not oral propranolol. Essential vocal tremors did not respond significantly to either treatment, perhaps due to the small number of patients, which is a limitation of this research.
Subject(s)
Humans , Propranolol/administration & dosage , Voice Disorders/drug therapy , Adrenergic beta-Agonists/administration & dosage , Botulinum Toxins, Type A/therapeutic use , Dystonic Disorders/drug therapy , Laryngeal Muscles/drug effects , Neuromuscular Agents/administration & dosage , Propranolol/therapeutic use , Tremor/drug therapy , Reproducibility of Results , Treatment Outcome , Statistics, Nonparametric , Electromyography , Injections, IntramuscularABSTRACT
This work investigated the measurement of vibrato and tremor extent values. Related works have not explored the possibility of measuring extent in the spectra of fundamental frequency (f(0)) low-frequency undulations. It is shown here that by canceling average (DC) values and baseline drifts of f(0) contours, as well as weighting the respective spectra by the time window DC value, extent measures can be promptly obtained in the frequency domain. The method is illustrated with measurements from synthetic and human data.
Subject(s)
Algorithms , Music , Signal Processing, Computer-Assisted , Speech Acoustics , Voice Disorders/diagnosis , Voice Quality , Adrenergic beta-Antagonists/therapeutic use , Female , Fourier Analysis , Humans , Male , Middle Aged , Propranolol/therapeutic use , Sound Spectrography , Speech Production Measurement , Time Factors , Treatment Outcome , Vibration , Voice Disorders/drug therapy , Voice Disorders/physiopathology , Voice Quality/drug effectsABSTRACT
OBJECTIVES/HYPOTHESIS: To evaluate the influence of age and gender on the required dose and resulting efficacy of botulinum toxin injection for adductor laryngeal dystonia. DESIGN: Retrospective chart review. METHODS: All patients treated with botulinum toxin for laryngeal dystonia at the University of Washington Medical Center between 1991 and 2008 were identified from a large clinical database. Only patients undergoing thyroarytenoid muscle injection for adductor laryngeal dystonia were included in this study. Each patient's gender, age at treatment, stable dose of botulinum toxin, and patient-reported duration of beneficial effect was recorded. RESULTS: A total of 155 patients (50 males, 105 females) were identified, with average ages of 50.6 years for men and 54.4 years for women. The mean treatment doses of botulinum toxin were 1.85 +/- 0.84 U for males and 2.15 +/- 1.40 U for females. The associated mean durations of beneficial effect were 12.8 +/- 7.7 weeks for males and 13.9 +/- 7.3 weeks for females. Neither the difference in dose nor in duration was found to be statistically significant (P = .395 and P = .511, respectively). When analyzed by age, the mean doses of botulinum toxin were 1.87 +/- 1.00 U for patients younger than 50 years and 2.20 +/- 1.41 U for the older group. The associated mean durations of beneficial effect were 13.7 +/- 7.4 weeks for the younger group and 13.5 +/- 7.4 weeks for the older group. Again, neither difference was found to be statistically significant (P = .113 and P = .730, respectively). CONCLUSIONS: Dosage and duration of beneficial effect of botulinum toxin in treatment of adductor laryngeal dystonia do not appear to vary with age or gender.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Neuromuscular Agents/administration & dosage , Voice Disorders/drug therapy , Adult , Aged , Aged, 80 and over , Dose-Response Relationship, Drug , Female , Humans , Injections, Intralesional , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Laryngeal dystonia or spasmodic dysphonia is characterized by involuntary and inappropriate spasms of vocal muscles, having the adductor type as the most common one. It is characterized by strain-strangled voice with pitch breaks. Diagnosis is made by means of videolaryngostroboscopic exam. The treatment of choice is done with botulinum toxin directly injected in the muscles responsible for the mismatched movement. The aim of this study is to report on an adductor- type dysphonia patient and to discuss the advantages and observations about this treatment reported in the literature.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Dystonia/complications , Laryngeal Muscles/drug effects , Neuromuscular Agents/therapeutic use , Voice Disorders/etiology , Dystonia/diagnosis , Dystonia/drug therapy , Female , Humans , Middle Aged , Treatment Outcome , Voice Disorders/diagnosis , Voice Disorders/drug therapyABSTRACT
Distonia laríngea, ou disfonia espasmódica, é caracterizada por contrações involuntárias e inapropriadas da musculatura responsável pela fonação, sendo a do tipo adutora a mais comum. Caracteriza-se por quebras fonatórias, sendo seu diagnóstico confirmado por videolaringoestroboscopia. O tratamento de escolha é feito com a aplicação direta de toxina botulínica nos músculos responsáveis pelo movimento incoordenado. O objetivo desse trabalho é relatar o caso de uma paciente com diagnóstico de distonia laríngea do tipo adutora, tratada com toxina botulínica e discutir as vantagens e observações descritas na literatura a respeito desse tratamento.
Laryngeal dystonia or spasmodic dysphonia is characterized by involuntary and innapropiate spasms of vocal muscles, having the adductor type as the most common one. It is chacterized by strain-strangled voice with pitch breaks. Diagnosis is made by means of videolaryngostroboscopic exam. The treatment of choice is done with botulinum toxin directly injected in the muscles responsible for the mismatched movement. The aim of this study is to report on an adductor- type dysphonia patient and to discuss the advantages and observations about this treatment reported in the literature.
Subject(s)
Humans , Female , Middle Aged , Neuromuscular Agents/therapeutic use , Dystonia/complications , Voice Disorders/etiology , Laryngeal Muscles/drug effects , Botulinum Toxins, Type A/therapeutic use , Dystonia/diagnosis , Dystonia/drug therapy , Voice Disorders/diagnosis , Voice Disorders/drug therapy , Treatment OutcomeABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the effect of nasal decongestant on nasalance scores for a group of 100 individuals. PARTICIPANTS: Forty-one subjects with hypernasality and 59 subjects without hypernasality underwent nasometric assessment at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil. DESIGN: Nasalance scores were obtained for each subject before the application of a nasal decongestant and again 10 minutes after subjects received a topical nasal decongestant applied into both nostrils. RESULTS: The nasalance scores obtained after the application of the nasal decongestant were significantly higher than those obtained before the decongestant. CONCLUSIONS: Nasal decongestion had a small but statistically significant effect on nasalance scores, suggesting that in some individuals, nasal congestion should be a variable of concern when using the Nasometer. Both nasal congestion (i.e., due to nasal rhinitis) and the effects of nasal decongestant sprays may influence Nasometer test results. Interpretation of nasalance scores, therefore, should be done carefully. Furthermore, nasometry, with and without nasal decongestant, can be a valuable clinical tool for screening anterior nasal obstruction, helping to isolate obstruction due to nasal congestion from structural obstruction in the nasal cavities.
Subject(s)
Nasal Decongestants/administration & dosage , Nasal Obstruction/diagnosis , Voice Disorders/physiopathology , Voice Quality , Administration, Inhalation , Adolescent , Adult , Analysis of Variance , Child , Child, Preschool , Female , Humans , Male , Phenylephrine/administration & dosage , Rhinomanometry/instrumentation , Rhinomanometry/methods , Sensitivity and Specificity , Speech Production Measurement , Voice Disorders/drug therapyABSTRACT
Este estudo descreve dados preliminares de eletromiografia laríngea (LEMG) e tratamento com toxina botulínica em pacientes com disfonia associada a distúrbios do movimento. Foram estudados 25 pacientes, 19 com distonia laríngea ou disfonia espasmódica, 5 com tremor vocal e 1 com síndrome de Gilles de la Tourette. LEMG realizada com eletrodos monopolares, antes da administração de toxina botulínica, foi compatível com distonia em 14 pacientes (normal em 5), sugeriu tremor essencial em 3 e Parkinson em 2. Os diferentes padrões de LEMG e melhora considerável obtida com administração de toxina botulínica instituíram LEMG como rotina no ambulatório de distúrbios do movimento da UNICAMP.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Botulinum Toxins/therapeutic use , Electromyography , Movement Disorders/diagnosis , Movement Disorders/drug therapy , Voice Disorders/diagnosis , Voice Disorders/drug therapy , Age Distribution , Botulinum Toxins/pharmacology , Elder Abuse , Larynx , Laryngeal Muscles/drug effects , Movement Disorders/complications , Sex Distribution , Voice Disorders/complicationsABSTRACT
This study describes preliminary laryngeal electromyography (LEMG) data and botulinum toxin treatment in patients with dysphonia due to movement disorders. Twenty-five patients who had been clinically selected for botulinum toxin administration were examined, 19 with suspected laryngeal dystonia or spasmodic dysphonia (SD), 5 with vocal tremor, and 1 with Gilles de la Tourette syndrome (GTS). LEMG evaluations were performed before botulinum toxin administration using monopolar electrodes. Electromyography was consistent with dystonia in 14 patients and normal in 5, and differences in frequency suggesting essential tremor in 3 and Parkinson tremors in 2. The different LEMG patterns and significant improvement in our patients from botulinum toxin therapy has led us to perform laryngeal electromyography as a routine in UNICAMP movement disorders ambulatory.
Subject(s)
Anti-Dyskinesia Agents/therapeutic use , Botulinum Toxins/therapeutic use , Electromyography , Movement Disorders/physiopathology , Voice Disorders/drug therapy , Adult , Age Distribution , Aged , Elder Abuse , Female , Humans , Laryngeal Muscles/drug effects , Larynx , Male , Middle Aged , Movement Disorders/complications , Movement Disorders/drug therapy , Sex Distribution , Voice Disorders/complications , Voice Disorders/physiopathologyABSTRACT
Disfonía espasmódica o distonía laríngea son los términos clínicos utilizados para referirse a una alteración neurológica central, de carácter crónico y progresivo. Históricamente estos enfermos han sido tratados por numerosos especialistas, sin resultados satisfactorios. Respecto al manejo otorrinolaringológico se ha intentado múltiples tratamientos, incluyendo la sección del nervio recurrente laríngeo, técnicas fonoquirúrgicas y el uso de fármacos, todos ellos con numerosos efectos adversos y malos resultados vocales. La terapia de elección, desde 1984, es la infiltración de toxina botulínica en la musculatura laríngea intrínseca distónica. El presente trabajo muestra la experiencia clínica con la inyección de toxina botulínica en 20 pacientes con distonía laríngea, realizada en el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile. Quince de ellos fueron infiltrados con esta toxina. Los restantes 5 pacientes no se inyectaron porque rechazaron este tratamiento. Se comparan los resultados vocales en ambos grupos, utilizando la escala de ranking vocal abreviada (Blitzer y cols., 1992), concluyéndose que los pacientes infriltrados mejoraron su voz; en cambio, quienes no se infiltraron permanecieron o progresaron en su compromiso vocal.
Subject(s)
Humans , Middle Aged , Anti-Dyskinesia Agents/pharmacology , Botulinum Toxins/pharmacology , Voice Disorders/drug therapy , Retrospective Studies , Injections , Botulinum Toxins/adverse effectsABSTRACT
Disfonia näo é um sintoma incomum em crianças. A maior parte dos estudos epidemiológicos refere uma prevalência entre 6 e 9 por cento de disfonia e distúrbios articulatórios na infância. As etiologias säo bastante diversas, variando desde alteraçöes no funcionamento dos órgäos fonoarticulatórios, até lesöes incapacitantes e com risco de vida. Os autores discutem as principais causas de disfonia entre crianças e adolescentes, enfatizando os aspectos mais importantes de seu diagnóstico e tratamento
Subject(s)
Humans , Male , Female , Child , Adolescent , Voice Disorders/etiology , Voice Disorders/diagnosis , Voice Disorders/drug therapy , Voice Disorders/therapyABSTRACT
Los autores revisan la literatura relacionada con el uso de la toxina botulínica, haciendo especial hincapié en las conclusiones del Consenso del Instituto Nacional de Salud de los Estados Unidos. Posteriormente se describen las indicaciones del uso de la toxina en las alteraciones de la voz y del espasmo del músculo cricofaríngeo, así como la técnica de inyección de la misma. Finalmente se analizan los resultados obtenidos en dos series de pacientes, describiendo los hallazgos, las dosis usadas y los efectos laterales observados
Subject(s)
Humans , Male , Female , Middle Aged , Voice Disorders/drug therapy , Myotonia/drug therapy , Botulinum Toxins/pharmacology , Injections, Intramuscular , Electromyography , Botulinum Toxins/administration & dosage , Botulinum Toxins/adverse effectsABSTRACT
A 16-year-old male patient who presented with muscle stiffness and dysphonia is described. Electromyography revealed continuous motor activity that was unaffected by peripheral nerve block or general anaesthesia, but was abolished by curare. The patient had a marked improvement after using phenytoin. The follow-up 11-years later corroborates with the proposed benignity of this syndrome, in spite of being dependent on medication.
Subject(s)
Muscle Rigidity/physiopathology , Muscles/physiopathology , Adolescent , Electromyography , Follow-Up Studies , Humans , Male , Motor Activity/physiology , Muscle Rigidity/diagnosis , Muscle Rigidity/drug therapy , Muscles/drug effects , Phenytoin/therapeutic use , Stiff-Person Syndrome/diagnosis , Stiff-Person Syndrome/drug therapy , Stiff-Person Syndrome/physiopathology , Voice Disorders/drug therapy , Voice Disorders/etiology , Voice Disorders/physiopathologyABSTRACT
É relatado o caso de um paciente de 16 anos de idade do sexo masculino com quadro de rigidez muscular e disfonia. Eletromiografia revelou atividade motora contínua que näo era alterada por bloqueio do nervo periférico ou anestesia geral, mas era abolida por curare. O paciente apresentou acentuada melhora após o uso de fenitoína. O seguimento do caso 11 anos mais tarde vem corroborar o proposto caráter benigno desta síndrome, apesar de o paciente ainda depender da medicaçäo