Laryngeal Dystonia

What Is Laryngeal Dystonia?

Laryngeal dystonia is an uncommon voice disorder caused by defective co-ordination of the muscles involved in speech production. Involuntary spasms of the vocal cords cause ‘breaks’ in speech and pitch variation, making it difficult for patients to finish words or even start them — leaving them unable to communicate effectively.

There are two main types of laryngeal dystonia. Adductor laryngeal dystonia mainly affects the muscles which pull the vocal cords together and accounts for 90% of cases. This causes a tight, “strangling” voice quality – often with abrupt starting and stopping of the voice. Alternatively, abductor laryngeal dystonia mainly affects those muscles which pull the vocal cords apart. This accounts for 10% of cases and causes a weak, breathy, whispering voice.

Diagnosing and Treating Laryngeal Dystonia

At The Harley Street ENT Clinic Dr Gerald Brookes, Consultant Voice Specialist, and Professor Renata Whurr, Speech and Language Therapist, offer unparalleled experience and care for patients suffering from laryngeal dystonia.

State-of-the-art equipment for comprehensive laryngeal examination is complemeted by Visispeech computerised voice analysis.

We provide the gold-standard of treatment for laryngeal dystonia with intra-laryngeal botulinum toxin injections carried out under EMG (Electromyography) control.

This treatment weakens the affected muscles and hence abolishes or significantly reduces the vocal cord tension and spasms.  These botulinum toxin injections block the motor end plates, which are the sites where the nerve fibres “plug” into the muscles.  Although the toxin remains active, new nerve shoots grow automatically which re-innervate the muscle and cause recurrent symptoms. Therefore patients require long term management with repeat injections.

The injections are administered under local anaesthetic as an Out-Patient procedure. Adductor patients usually have injections to both vocal cords at the same visit whilst abductor patients only have injections to one side at a time. Typically a second injection is given tomthe opposite side 3-4 weeks later. 

The muscles involved are deep under the skin and therefore effectively “invisible”.  EMG is required to identify the correct muscles to be treated.  There is a wide range of individual sensitivity to the toxin, which can only be established by assessing a patient’s unique treatment response. 

Over 90% of patients will benefit for periods of 3 to 6 months after the injections, once the most appropriate dosage has been established.  Re-treatment will then almost inevitably be required as the spontaneous remission rate is less than 2%.

Are There Any Possible Adverse Affects Of The Intervention?

Adverse reactions to treatment are incredibly low with transient swallowing difficulties occurring in less than 10% of injection and which quickly resolve.

Are You Suffering From Laryngeal Dystonia?

If you think you may be experiencing laryngeal dystonia, please contact us at The Harley Street ENT Clinic. Dr Gerald Brookes pioneered the treatment of laryngeal dystonia in the UK 25 years ago. He remains the leading national specialist in this field and can diagnose and commence treatment swiftly and effectively – helping you to feel better as soon as possible.

We also run an NHS Neuro-Laryngology service each fortnight, in which patients can be assessed and treated without direct charge after prior authorisation by their GP and local NHS contracting service.