FRCS (ORL-HNS) · SECTION 1 SBA

Adductor laryngeal dystonia

A 45-year-old has task-specific strained, strangled speech with intermittent breaks on voiced sentences; whispering and singing are relatively preserved. What is first-line treatment?

CHOOSE ONE ANSWER

Best of five

  1. A. Empirical proton-pump inhibitor indefinitely
  2. B. Bilateral vocal-fold stripping
  3. C. Urgent tracheostomy
  4. D. Antibiotics
  5. E. EMG-guided botulinum toxin injection into the adductor laryngeal muscles
ANSWER AND REASONING

E. EMG-guided botulinum toxin injection into the adductor laryngeal muscles

The task-specific pattern is typical of adductor laryngeal dystonia, for which targeted chemodenervation is established symptomatic treatment.

Why every option is right or wrong

A. Empirical proton-pump inhibitor indefinitely: Reflux does not explain task-specific phonatory breaks.

B. Bilateral vocal-fold stripping: Destructive mucosal surgery is inappropriate.

C. Urgent tracheostomy: There is no airway obstruction in the scenario.

D. Antibiotics: There is no infectious syndrome.

E. EMG-guided botulinum toxin injection into the adductor laryngeal muscles: The task-specific pattern is typical of adductor laryngeal dystonia, for which targeted chemodenervation is established symptomatic treatment.

What if the scenario changed?

If the tremor occurred equally during quiet breathing, palate movement and sustained vowels, essential voice tremor would become more likely.

EDUCATIONAL USE

Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.

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