What Is New in Laryngeal Dystonia: Review of Novel Findings of Pathophysiology and Novel Treatment Options
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NEUROLARYNGOLOGY (AJ MCWHORTER AND L ADKINS, SECTION EDITORS)
What Is New in Laryngeal Dystonia: Review of Novel Findings of Pathophysiology and Novel Treatment Options Necati Enver 1,2
&
Michael J. Pitman 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The aim of this review is to present the current literature on pathophysiology, evaluation, and management of laryngeal dystonia. Recent Findings Recent evidence suggests loss of cortical inhibition, and sensory dysfunction plays an important role in the pathophysiology of laryngeal dystonia. New treatments addressing these changes include electrical stimulation for neuromodulation of the larynx, vibrotactile therapy, and sodium oxybate. Preliminary investigations are promising and these may impact the future of care for laryngeal dystonia patients. Summary The current literature emphasizes a new understanding of the pathophysiology of laryngeal dystonia which has led to investigation of novel therapies. Keywords Spasmodic dysphonia . Laryngeal dystonia . Novel treatment . Surgery . Pathophysiology
Introduction Laryngeal dystonia (LD), also known as spasmodic dysphonia, is a task-specific focal movement disorder primarily effecting voice production [1]. The dystonic movements of the vocal folds result in a varied phenomenology, typically hard vocal breaks and strain in the adductor-type laryngeal dystonia (ADLD), and breathy breaks or aphonia in the abductor-type laryngeal dystonia (ABLD). More than 80% of patients have suffered from ADLD [2]. By comparison, 17% of patients have suffered from ABLD [1]. In addition This article is part of the Topical collection on Neurolaryngology * Necati Enver [email protected] Michael J. Pitman [email protected] 1
The Center of Voice and Swallowing, Department of Otolaryngology–Head and Neck Surgery, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, Harkness Pavilion 8-863, 180 Fort Washington Avenue, New York, NY 10032, USA
2
Department of Otolaryngology–Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, NY, USA
to these two main types of LD, there are also uncommon forms such as mixed adductor/abductor laryngeal dystonia, singer’s dystonia, and adductor respiratory dystonia. The disease was first described 150 years ago and recognized as a psychogenic origin disorder. In 1980 Moore’s highspeed laryngeal imaging confirmed the vocal breaks in ADLD were due to irregular contractions of the vocal fold adductor muscles [3, 4]. Laryngeal dystonia is listed as a rare disease by the National Institutes of Health with an incidence of 1–4/ 100,000 primarily affecting women (2.5:1) [5, 6]. The average age of onset is 30–50 years old. While a causative relationship has not been established, many environmental factors associated with the disease have been identified. Twenty-one percent of patients chronologically associate the onset of symptoms with a significantly stressful emotional event. It ha
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