Objective: To evaluate voice function in patients with adductor spasmodic dysphonia (AdSD) who discontinued botulinum toxin (BTX) treatment because they felt that their voice had improved sufficiently. Patients and Methods: Twenty-eight patients quit treatment in 2004, of whom 20 fulfilled the inclusion criteria for the study, with 3 subsequently excluded because of return of symptoms, leaving 17 patients (11 males, 6 females) included in this follow-up study. A questionnaire concerning current voice function and the Voice Handicap Index were completed. Audio-perceptual voice assessments were done by 3 listeners. The inter- and intrarater reliabilities were r > 0.80. Results: All patients had a subjectively good stable voice, but with differences in their audio-perceptual voice assessment scores. Based on the pre-/posttreatment auditory scores on the overall degree of AdSD, patients were divided into 2 subgroups showing more and less improvement, with 10 and 7 patients, respectively. The subgroup with more improvement had shorter duration from the onset of symptoms until the start of BTX treatment, and included 7 males compared to only 4 males in the subgroup with less improvement. Conclusion: It seems plausible that the symptoms of spasmodic dysphonia may decrease over time. Early intervention and male gender seem to be important factors for long-term reduction of the voice symptoms of AdSD.

Keywords:
Spasmodic dysphonia, Botulinum toxin, Discontinuation of treatment, Long-term follow-up, Improved voice
1.
Blitzer A, Brin MF, Stewart CF: Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 1998;108:1435-1441.
2.
Pearson EJ, Sapienza CM: Historical approaches to the treatment of adductor-type spasmodic dysphonia (ADSD): review and tutorial. NeuroRehabilitation 2003;18:325-338.
3.
Sapienza CM, Murry T, Brown W: Variations in adductor spasmodic dysphonia: acoustic evidence. J Voice 1998;12:214-222.
4.
Langeveld TP, Drost HA, Frijns JH, Zwinderman AH, Baatenburg De Jong RJ: Perceptual characteristics of adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol 2000;109:741-748.
5.
Lindestad P, Hertegård S, Ylitalo R: Effects of botulinum toxin treatment for adductor spasmodic dysphonia on voice and social function. Logoped Phoniatr Vocol 1997;22:129-134.
6.
Langeveld TP, Luteijn F, van Rossum M, Drost HA, Baatenburg de Jong RJ: Adductor spasmodic dysphonia and botulinum toxin treatment: the effect on well-being. Ann Otol Rhinol Laryngol 2001;110:941-945.
7.
Wingate JM, Ruddy BH, Lundy DS, Lehman J, Casiano R, Collins SP, Woodson GE, Sapienza C: Voice Handicap Index results for older patients with adductor spasmodic dysphonia. J Voice 2005;19:124-131.
8.
Whurr R, Lorch M: Review of differential diagnosis and management of spasmodic dysphonia. Curr Opin Otolaryngol Head Neck Surg 2016;24:203-207.
9.
Izdebski K, Dedo HH, Boles L: Spastic dysphonia: a patient profile of 200 cases. Am J Otolaryngol 1984;5:7-14.
10.
Patel AB, Bansberg SF, Adler CH, Lott DG, Crujido L: The Mayo Clinic Arizona spasmodic dysphonia experience: a demographic analysis of 718 patients. Ann Otol Rhinol Laryngol 2015;124:859-863.
11.
Tisch S, Brake H, Law M, Cole I, Darveniza P: Spasmodic dysphonia: clinical features and effects of botulinum toxin therapy in 169 patients - an Australian experience. J Clin Neurosci 2003;10:434-438.
12.
Ludlow CL, Naunton RF, Sedory SE, Schulz GM, Hallett M: Effects of botulinum toxin injections on speech in adductor spasmodic dysphonia. Neurology 1988;38:1220-1225.
13.
Bielamowicz S, Stager SV, Badillo A, Godlewski A: Unilateral versus bilateral injections of botulinum toxin in patients with adductor spasmodic dysphonia. J Voice 2002;16:117-123.
14.
Courey MS, Garrett CG, Billante CR, Stone RE, Portell MD, Smith TL, Netterville JL: Outcomes assessment following treatment of spasmodic dysphonia with botulinum toxin. Ann Otol Rhinol Laryngol 2000;109:819-822.
15.
Sulica L: Contemporary management of spasmodic dysphonia. Curr Opin Otolaryngol Head Neck Surg 2004;12:543-548.
16.
Ohlsson A, Dotevall H: Voice handicap index in Swedish. Logoped Phoniatr Vocol 2009;34:60-66.
17.
Granqvist S: The Visual Sort and Rate method for perceptual evaluation in listening tests. Logoped Phoniatr Vocol 2003;28:109-116.
18.
Chan KM, Yiu EM: The effect of anchors and training on the reliability of perceptual voice evaluation. J Speech Lang Hear Res 2002;45:111-126.
19.
Hu A, Hillel A, Meyer T: Factors associated with patient-perceived hoarseness in spasmodic dysphonia patients. J Voice 2015, Epub ahead of print.
20.
Rosen CA, Lee AS, Osborne J, Zullo T, Murry T: Development and validation of the Voice Handicap Index-10. Laryngoscope 2004;114:1549-1556.
21.
Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, Newman CW: The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol 1997;6:66-70.
22.
Davidson BJ, Ludlow CL: Long-term effects of botulinum toxin injections in spasmodic dysphonia. Ann Otol Rhinol Laryngol 1996;105:33-42.
23.
Vanryckeghem M, Ruddy BH, Lehman J: Behavior Assessment Battery: a pilot study of the affective, behavioral, and cognitive correlates surrounding spasmodic dysphonia. J Voice 2016;30:53-60.
24.
Paniello RC, Barlow J, Serna JS: Longitudinal follow-up of adductor spasmodic dysphonia patients after botulinum toxin injection: quality of life results. Laryngoscope 2008;118:564-568.
25.
Chhetri DK, Merati AL, Blumin JH, Sulica L, Damrose EJ, Tsai VW: Reliability of the perceptual evaluation of adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol 2008;117:159-165.
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2016
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