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Can Botox help to ease psychogenic dysphonia?

Q - A patient developed an odd hoarse voice after her son suddenly died. She was told it was psychological but now she has been offered Botox. Is this appropriate?

A - Spasmodic dysphonia is a recognised neurogenic condition in the form of focal dystonia, although it has been regarded historically as a rare psychogenic condition.

The onset of adductor spasmodic dysphonia is usually in middle age, with a greater incidence in women. Typically, the patient presents with an effortful initiation of voicing, with a strained-strangled vocal quality. Vegetative vocal behaviours such as coughing and singing may be normal.

The diagnosis should be made by a multidisciplinary team of a neurologist, laryngologist and speech and language therapist using fibreoptic nasoendoscopy.

Laryngoscopic findings will demonstrate normal laryngeal structure, with some intermittent involuntary hyperadduction of the vocal folds and disruption of phonation by laryngospasm.

Injections of botulinum toxin with voice therapy can improve voice quality. They need to be repeated every three months on average.

Dr Ruth Epstein is head of speech and language therapy, Royal Throat, Nose and Ear Hospital, London

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