Hostname: page-component-848d4c4894-pjpqr Total loading time: 0 Render date: 2024-06-15T00:16:17.840Z Has data issue: false hasContentIssue false

Spasmodic dysphonia: a seven-year audit of dose titration and demographics in the Indian population

Published online by Cambridge University Press:  07 July 2014

N K Nerurkar*
Department of ENT, Bombay Hospital, Mumbai, India
T P Banu
Department of ENT, Bombay Hospital, Mumbai, India
Address for correspondence:Dr Nupur Kapoor Nerurkar, D-603 Simla House, Napean Sea Road, Mumbai – 400026, Maharashtra, India E-mail:



This study aimed to evaluate the demographics of spasmodic dysphonia in the Indian population and to analyse the optimum dose titration of botulinum toxin type A in this group. A comparative analysis with international studies was also performed.


The study involved a retrospective analysis and audit of botulinum toxin type A dose titration in spasmodic dysphonia patients who visited our voice clinic between January 2005 and January 2012.


The average total therapeutic dose required for patients with adductor spasmodic dysphonia was 4.2 U per patient per vocal fold (total 8.4 U per patient), and for patients with abductor spasmodic dysphonia, it was 4.6 U per patient.


Our audit revealed that 80 per cent of the spasmodic dysphonia patients were male, which contrasts dramatically with international studies, wherein around 80 per cent of spasmodic dysphonia patients were female. Our study also revealed a higher dose titration of botulinum toxin for the Indian spasmodic dysphonia population in both adductor and abductor spasmodic dysphonia cases.

Main Articles
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Presented as a poster (and awarded the David Howard prize for best poster presentation) at the Laryngology 2012 conference, 1–3 June 2012, Kuala Lumpur, Malaysia.


1Cannito, MP, Johnson, JP. Spastic dysphonia: a continuum disorder. J Commun Disord 1981;14:215–33CrossRefGoogle ScholarPubMed
2Adler, CH, Edwards, BW, Bansberg, SF. Female predominance in spasmodic dysphonia. J Neurol Neurosurg Psychiatry 1997;63:688Google Scholar
3Erickson, ML. Effects of voicing and syntactic complexity on sign expression in adductor spasmodic dysphonia. Am J Speech Lang Pathol 2003;12:416–24CrossRefGoogle ScholarPubMed
4Blitzer, A, Brin, MF, Stewart, CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 1998;108:1435–41Google Scholar
5Menon, JR. Flaring of ala nasi: a reliable diagnostic sign for abductor spasmodic dysphonia. International Journal of Phonosurgery and Laryngology 2011;1:41–3CrossRefGoogle Scholar
6Rodriquez, AA, Ford, CN, Bless, DM, Harmon, RL. Electromyographic assessment of spasmodic dysphonia patients prior to botulinum toxin injection. Electromyogr Clin Neurophysiol 1994;34:403–7Google Scholar
7Rontal, M, Rontal, E, Rolnick, M, Merson, R, Silverman, B, Truong, DD. A method for the treatment of abductor spasmodic dysphonia with botulinum toxin injections: a preliminary report. Laryngoscope 1991;101:911–4CrossRefGoogle ScholarPubMed
8Woodson, GE, Zwirner, P, Murry, T, Swenson, M. Use of flexible fiberoptic laryngoscopy to assess patients with spasmodic dysphonia. J Voice 1991;5:8591Google Scholar
9Klotz, DA, Maronian, NC, Waugh, PF, Shahinfar, A, Robinson, L, Hillel, AD. Findings of multiple muscle involvement in a study of 214 patients with laryngeal dystonia using fine wire electromyography. Ann Otol Rhinol Laryngol 2004;113:602–12Google Scholar
10Simonyan, K, Ludlow, CL. Abnormal activation of the primary somatosensory cortex in spasmodic dysphonia: an fMRI study. Cereb Cortex 2010;20:2749–59Google Scholar
11Marsden, CD, Obeso, JA, Zarranz, JJ, Lang, AE. The anatomical basis of symptomatic hemidystonia. Brain 1985;108:463–83Google Scholar
12Blitzer, A, Brin, MF. Laryngeal dystonia: a series with botulinum toxin therapy. Ann Otol Rhinol Laryngol 1991;100:85–9Google Scholar
13Blitzer, A, Sulica, L. Botulinum toxin: basic science and clinical uses in otolaryngology. Laryngoscope 2001;111:218–26Google Scholar
14Pou, AM, Gadre, AK, Muller, CD. The Use of Botulinum Toxin in Otolaryngology: A Practical Guide. Alexandria, VA: American Academy of Otolaryngology – Head and Neck Surgery Foundation, 2005Google Scholar
15Rosow, DE, Parikh, P, Vivero, RJ, Casiano, RR, Lundy, DS. Considerations for initial dosing of botulinum toxin in treatment of adductor spasmodic dysphonia. Otolaryngol Head Neck Surg 2013;148:1003–6Google Scholar
16Birkent, H, Maronian, N, Waugh, P, Merati, AL, Perkel, D, Hillel, AD. Dosage changes in patients with long-term botulinum toxin use for laryngeal dystonia. Otolaryngol Head Neck Surg 2009;140:43–7CrossRefGoogle ScholarPubMed