Surgery to treat vocal-cord spasms shows high success rate

May 14, 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 David 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 David 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.
Chhetri's coauthors included Berke, Bruce Gerratt, Ph.D., Jody Kreiman, Ph.D., and Abie Mendelsohn, all of the UCLA Division of Head and Neck Surgery, which funded the research.

Berke has trained surgeons around the world in the surgical technique, called laryngeal denervation and reinnervation, which is performed almost exclusively in the United States at UCLA Medical Center.

University of California - Los Angeles

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