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November 28, 1990, Vol 264, No. 20 >
ARTICLE | November 28, 1990

Treatment of Speech and Voice Disorders With Botulinum Toxin FREE

Christy L. Ludlow, PhD
[+] Author Affiliations

Reprint requests to Bldg 10, Room 5D38, National Institutes of Health, Bethesda, MD 20892 (Dr Ludlow).


JAMA. 1990;264(20):2671-2675. doi:10.1001/jama.1990.03450200079035
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References

SELECTED CASE  A 37-YEAR-OLD woman presented to the Speech and Voice Unit of the National Institutes of Health, Bethesda, Md, with a 5-year history of a voice disorder of unknown etiology. The disorder began after an upper respiratory infection, when she developed hoarseness that persisted for several weeks. Indirect laryngoscopy 1 month after onset revealed no abnormalities: the vocal folds appeared normal and moved symmetrically. The symptoms progressed during the succeeding months; her voice became difficult to control, with frequent pitch and voice breaks. Speech therapy provided no lasting benefit. Because she had been undergoing a divorce and had a stressful job, her physician suggested psychological counseling. She discontinued counseling after a 3-month trial afforded no benefit. The symptoms progressed during the next 2 years and then stabilized, sometimes aggravated by stress and voice use. During the next few years she sought relief with hypnosis, acupuncture, and various medications, including

REFERENCES

1 +
Aronson AE, DeSanto LW.  Adductor spasmodic dysphonia: three years after recurrent nerve section . Laryngoscope . 1983;;93:1-8.
2 +
Aronson AE, Brown JR, Litin EM, Pearson JS.  Spastic dysphonia, I: voice, neurologic, and psychiatric aspects . J Speech Hear Disord. 1968;;33:203-218.
3 +
Robe E, Brumlik J, Moore P.  A study of spastic dysphonia: neurologic and electroencephalographic abnormalities . Laryngoscope . 1960;;70:219-245.
4 +
Feldman M, Nixon JV, Finitzo-Hieber T, Freeman FJ.  Abnormal parasympathetic vagal function in patients with spasmodic dysphonia . Ann Intern Med. 1984;;100:491-495.
5 +
Schaefer SD, Finitzo-Hieber T, Gerling IJ, Freeman FJ.  Brainstem conduction abnormalities in spasmodic dysphonia . Ann Otol Rhinol Laryngol. 1983;;92:59-63.
6 +
Cohen LG, Ludlow CL, Warden BS, et al.  Blink reflex excitability recovery curves in patients with spasmodic dysphonia . Neurology . 1989;;39:572-577.
7 +
Blitzer A, Brin MF, Fahn S, Lovelace RE.  Clinical laboratory characteristics of focal laryngeal dysphonia: study of 110 cases . Laryngoscope . 1988;; 98:636-640.
8 +
Ludlow CL, Connor NP.  Dynamic aspects of phonatory control in spasmodic dysphonia . J Speech Hear Res. 1987;;30:197-206.
9 +
Ludlow CL, Baker M, Naunton RF, Hallett M.  Intrinsic laryngeal muscle activation in spasmodic dysphonia . In: Benecke R, Conrad B, Marsden CD, eds. Motor Disturbances, I . Orlando, Fla: Academic Press Inc; 1987;:119-130.
10 +
Ludlow CL, Hallett M, Sedory SE, Fujita M, Naunton RF.  The pathophysiology of spasmodic dysphonia and its modification by botulinum toxin . In: Berardelli A, Benecke R, Manfredi M, Marsden CD, eds. Motor Disturbances, II . Orlando, Fla: Academic Press Inc; 1990;:274-288.
11 +
Scott AB, Kennedy RA, Stubbs HA.  Botulinum toxin injection as a treatment for blepharospasm . Arch Ophthalmol. 1985;;103:347-350.
12 +
Miller RH, Woodson GE, Jankovic J.  Botulinum toxin injection of the vocal fold for spasmodic dysphonia: a preliminary report . Arch Otolaryngol Head Neck Surg. 1987;;113:603-605.
13 +
Blitzer A, Brin MF, Fahn S, Lange D, Lovelace RE. Letter to the editor. Laryngoscope . 1986;; 96:1300-1301.
14 +
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.
15 +
Dedo HH, Izdebski K.  Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia . Laryngoscope . 1983;;93:9-16.
16 +
Ludlow CL, Naunton RF, Fujita M, Sedory SE.  Spasmodic dysphonia: botulinum toxin injection after recurrent nerve surgery . Otolaryngol Head Neck Surg. 1990;;102:102-122.
17 +
Freeman FJ, Ushijima T.  Laryngeal muscle activity during stuttering . J Speech Hear Res. 1978;;21:538-562.
18 +
Shapiro AI.  An electromyographic analysis of the fluent and dysfluent utterances of several types of stutterers . J Fluency Disord. 1980;;5:203-231.
19 +
Shapiro AI, DeCicco BA.  The relationship between normal dysfluency and stuttering: an old question revisited . J Fluency Disord. 1982;;7:109-121.
20 +
Wingate M.  A standard definition of stuttering . J Speech Hear Disord. 1964;;29:484-489.

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1 +
Aronson AE, DeSanto LW.  Adductor spasmodic dysphonia: three years after recurrent nerve section . Laryngoscope . 1983;;93:1-8.
2 +
Aronson AE, Brown JR, Litin EM, Pearson JS.  Spastic dysphonia, I: voice, neurologic, and psychiatric aspects . J Speech Hear Disord. 1968;;33:203-218.
3 +
Robe E, Brumlik J, Moore P.  A study of spastic dysphonia: neurologic and electroencephalographic abnormalities . Laryngoscope . 1960;;70:219-245.
4 +
Feldman M, Nixon JV, Finitzo-Hieber T, Freeman FJ.  Abnormal parasympathetic vagal function in patients with spasmodic dysphonia . Ann Intern Med. 1984;;100:491-495.
5 +
Schaefer SD, Finitzo-Hieber T, Gerling IJ, Freeman FJ.  Brainstem conduction abnormalities in spasmodic dysphonia . Ann Otol Rhinol Laryngol. 1983;;92:59-63.
6 +
Cohen LG, Ludlow CL, Warden BS, et al.  Blink reflex excitability recovery curves in patients with spasmodic dysphonia . Neurology . 1989;;39:572-577.
7 +
Blitzer A, Brin MF, Fahn S, Lovelace RE.  Clinical laboratory characteristics of focal laryngeal dysphonia: study of 110 cases . Laryngoscope . 1988;; 98:636-640.
8 +
Ludlow CL, Connor NP.  Dynamic aspects of phonatory control in spasmodic dysphonia . J Speech Hear Res. 1987;;30:197-206.
9 +
Ludlow CL, Baker M, Naunton RF, Hallett M.  Intrinsic laryngeal muscle activation in spasmodic dysphonia . In: Benecke R, Conrad B, Marsden CD, eds. Motor Disturbances, I . Orlando, Fla: Academic Press Inc; 1987;:119-130.
10 +
Ludlow CL, Hallett M, Sedory SE, Fujita M, Naunton RF.  The pathophysiology of spasmodic dysphonia and its modification by botulinum toxin . In: Berardelli A, Benecke R, Manfredi M, Marsden CD, eds. Motor Disturbances, II . Orlando, Fla: Academic Press Inc; 1990;:274-288.
11 +
Scott AB, Kennedy RA, Stubbs HA.  Botulinum toxin injection as a treatment for blepharospasm . Arch Ophthalmol. 1985;;103:347-350.
12 +
Miller RH, Woodson GE, Jankovic J.  Botulinum toxin injection of the vocal fold for spasmodic dysphonia: a preliminary report . Arch Otolaryngol Head Neck Surg. 1987;;113:603-605.
13 +
Blitzer A, Brin MF, Fahn S, Lange D, Lovelace RE. Letter to the editor. Laryngoscope . 1986;; 96:1300-1301.
14 +
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.
15 +
Dedo HH, Izdebski K.  Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia . Laryngoscope . 1983;;93:9-16.
16 +
Ludlow CL, Naunton RF, Fujita M, Sedory SE.  Spasmodic dysphonia: botulinum toxin injection after recurrent nerve surgery . Otolaryngol Head Neck Surg. 1990;;102:102-122.
17 +
Freeman FJ, Ushijima T.  Laryngeal muscle activity during stuttering . J Speech Hear Res. 1978;;21:538-562.
18 +
Shapiro AI.  An electromyographic analysis of the fluent and dysfluent utterances of several types of stutterers . J Fluency Disord. 1980;;5:203-231.
19 +
Shapiro AI, DeCicco BA.  The relationship between normal dysfluency and stuttering: an old question revisited . J Fluency Disord. 1982;;7:109-121.
20 +
Wingate M.  A standard definition of stuttering . J Speech Hear Disord. 1964;;29:484-489.

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