The treatment of adductor spasmodic dysphonia using botulinum toxin A was conducted in 13 patients as a double-blind, placebo-controlled study. Patients were diagnosed independently by an interdisciplinary team consisting of speech pathologists, an otolaryngologist, and a neurologist. The toxin or saline was injected into each thyroarytenoid muscle under electromyographic and laryngoscopic guidance. Botulinum toxin A markedly reduced perturbation, decreased fundamental frequency range, and improved the spectrographic characteristics of the voice. Fundamental frequency and phonation time remained unchanged. Patients injected with botulinum toxin A noticed significant improvement in their voices in comparison with the placebo-treated group. Excessive breathiness of the voice occurred in two patients, and mild bleeding in one patient in the botulinum toxin A-treated group. Injection with saline resulted in edema of the vocal cord in one patient. Botulinum toxin A proved to be an effective and safe treatment of adductor spasmodic dysphonia.

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Permanent objective evaluation of vocal changes associated with laryngeal pathology is a goal which has been difficult for the laryngologist and speech pathologist to attain. Most attempts at achieving objective records have focused on direct visual examination of the larynx using techniques such as high speed photography, x-ray studies or histologic sectioning. However, the important subjective qualities of the voice are difficult to translate into objective visual patterns. In order to produce these patterns, certain individual components of the voice ( i.e., breathiness, periodicity and formant structure) must be analyzed. Recently, modifications of the sound spectrograph have enabled the clinician to objectively visualize these components. The patterns produced by the spectrograph may be applied to a variety of clinical situations. For example, the technique aids greatly in determining the success or failure of medical and surgical management for vocal cord lesions. Secondly, voice spectrography can readilv show improvements or deficiencies in vocal rehabilitation for functional dysphonia. Lastly, this method provides an objective, permanent record of the voice which may be useful from a medicolegal standpoint. Sound spectrographic analysis of vocal pathology is an important diagnostic tool for the clinician. Its future use should be encouraged as a more precise aid in the evaluation of the voice.

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A portable voice intensity controller (VIC) was used in a treatment program for patients with dysphonia related to vocal cord lesions and to laryngeal hypertension. The device, worn in daily speaking situations, provided auditory feedback contingent on excessive vocal intensity. Consequently, a soft vocal level was automatically maintained even in the presence of high-level environmental noise. The device proved to be an aid to vocal rehabilitation for the 32 patients who were studied.