FRCS (ORL-HNS) · SECTION 1 SBA

Spasmodic dysphonia

A patient has task-specific strained, intermittent voice breaks that improve when singing and worsen during connected speech. Laryngoscopy shows no mass. What is the most likely diagnosis?

CHOOSE ONE ANSWER

Best of five

  1. A. Unilateral vocal-fold paralysis
  2. B. Adductor laryngeal dystonia
  3. C. Muscle-tension dysphonia alone
  4. D. Early glottic carcinoma
  5. E. Presbyphonia
ANSWER AND REASONING

B. Adductor laryngeal dystonia

Task-specific involuntary adduction causing strained breaks, with sensory tricks or improvement during singing, is characteristic. Botulinum toxin is a standard symptomatic treatment after expert voice assessment.

Why every option is right or wrong

A. Unilateral vocal-fold paralysis: This usually causes a persistent breathy weak voice.

B. Adductor laryngeal dystonia: Task-specific involuntary adduction causing strained breaks, with sensory tricks or improvement during singing, is characteristic. Botulinum toxin is a standard symptomatic treatment after expert voice assessment.

C. Muscle-tension dysphonia alone: That is often continuous and responds to voice therapy without dystonic breaks.

D. Early glottic carcinoma: A structural lesion should be visible and symptoms are not typically task-specific.

E. Presbyphonia: Age-related bowing causes breathiness rather than spasmodic breaks.

What if the scenario changed?

If the breaks were breathy during voiceless consonants, abductor laryngeal dystonia would be considered.

EDUCATIONAL USE

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

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