Vocal Cord spasms - new treatment/study

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Surgical technique provides the first permanent solution to treating

vocal-cord spasms

Medical Procedure News Sunday, 15-May-2005

The first large, long-term study of patients who had surgery to

control vocal-cord spasms showed excellent results in the majority of

cases, reports new UCLA research presented May 14 at the 126th Annual

Meeting of the American Laryngological Association.

" We are very encouraged by our results, " said Dr. Dinesh Chhetri,

assistant professor of head and neck surgery at the Geffen

School of Medicine at UCLA, who presented the findings. " When

spasmodic dysphonia symptoms do not return within one year, they

generally will not be coming back. Our findings suggest that this

surgical technique provides the first permanent solution to treating

the condition. "

Spasmodic dysphonia is a neurological condition that disrupts nervous

signals to the vocal cords, preventing them from vibrating properly.

The voice is reduced to a strangled, broken whisper, interfering with

a person's ability to communicate and enjoy a successful career and

personal life. The disorder affects 50,000 people in the United

States, and its cause remains unknown.

In 1989, the FDA approved the use of Botox injections into the vocal

cords. Required every few months, these treatments temporarily

relieve the symptoms, but not the disorder. At up to $2,000 a pop,

the shots are pricey as well as uncomfortable and time-consuming.

Some patients also can develop Botox resistance.

In 1993, Dr. Gerald Berke, chief of head and neck surgery at the

Geffen School of Medicine at UCLA, pioneered the first surgery

to permanently treat spasmodic dysphonia symptoms. The surgeon severs

the nerve sending abnormal signals to the vocal cords, and then

attaches a healthy nerve from the throat to maintain the vocal cords'

muscle tone.

Chhetri and his colleagues surveyed 131 patients at an average of

four years post-surgery. Eighty-one patients completed the

questionnaire. Of these patients, 91 percent expressed greater

satisfaction with their vocal quality post-surgery compared to post-

Botox. Overall, 83 percent noted that the procedure significantly

improved their physical, social and emotional well-being.

In part two of the study, the researchers asked UCLA speech

pathologists and voice disorders experts to listen to patients' pre-

operative and post-operative voice samples. Of the total 81-patient

sample, this evaluation was limited to 46 patients who possessed a

pre-operative vocal recording.

In a blind, randomized comparison, the team detected no voice breaks

in 74 percent of the post-operative sample. Fifteen percent of the

patients still experienced mild voice breaks, four percent were rated

moderate and seven percent considered severe. Breathiness remained in

up to 30 percent of the post-operative patients, but was rated severe

in only six percent.

" The surgery continued to provide long-lasting resolution of vocal

cord spasms and voice breaks in a majority of patients, " said

Chhetri. " This suggests the procedure will expand as an important

therapeutic technique for treating spasmodic dysphonia. "

" Our next step will be to recruit and study more patients to better

understand how and why the surgery is effective, " he added. " We want

to identify what causes spasmodic dysphonia and gain insights into

how the surgical results vary for different people. "

Typically appearing between the ages of 30 and 50, spasmodic

dysphonia at first sounds like laryngitis, or a scratchy throat. As

the disorder worsens, patients are rendered nearly mute and left with

a half-broken voice. Many listeners mistake the disorder for

stuttering, a contagious illness or mental incapacity.

People who suffer from spasmodic dysphonia are forced to surrender

the personal opinions that define them as a person. They're unable to

contribute to conversations on work projects, family, religion,

politics and pop culture. Telephone communication and job interviews

become impossible. The difficulties are especially pronounced in the

elderly, whose friends may have difficulty hearing even without the

challenge of interpreting spasmodic speech.

http://www.ucla.edu/