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UCLA researchers present the first long-term follow-up on a large population
of patients who had surgery to control vocal-cord spasms.
The first large, long-term study of patients who had
surgery to control vocal-cord spasms showed excellent
results in the majority of cases, reports new UCLA research
presented May 14 at the 126th Annual Meeting of the American
"We are very encouraged by our results," said Dr. Dinesh Chhetri,
assistant professor of head and neck surgery at the David Geffen
School of Medicine at UCLA, who presented the findings. "When
spasmodic dysphonia symptoms do not return within one year, they
generally will not be coming back. Our findings suggest that this
surgical technique provides the first permanent solution to treating
Spasmodic dysphonia is a neurological condition that disrupts
nervous signals to the vocal cords, preventing them from vibrating
properly. The voice is reduced to a strangled, broken whisper,
interfering with a person's ability to communicate and enjoy a
successful career and personal life. The disorder affects 50,000
people in the United States, and its cause remains unknown.
In 1989, the FDA approved the use of Botox injections into the
vocal cords. Required every few months, these treatments temporarily
relieve the symptoms, but not the disorder. At up to $2,000 a pop,
the shots are pricey as well as uncomfortable and time-consuming.
Some patients also can develop Botox resistance.
In 1993, Dr. Gerald Berke, chief of head and neck surgery at the
David Geffen School of Medicine at UCLA, pioneered the first surgery
to permanently treat spasmodic dysphonia symptoms. The surgeon
severs the nerve sending abnormal signals to the vocal cords, and
then attaches a healthy nerve from the throat to maintain the vocal
cords' muscle tone.
Chhetri and his colleagues surveyed 131 patients at an average of
four years post-surgery. Eighty-one patients completed the
questionnaire. Of these patients, 91 percent expressed greater
satisfaction with their vocal quality post-surgery compared to post-Botox.
Overall, 83 percent noted that the procedure significantly improved
their physical, social and emotional well-being.
In part two of the study, the researchers asked UCLA speech
pathologists and voice disorders experts to listen to patients'
pre-operative and post-operative voice samples. Of the total
81-patient sample, this evaluation was limited to 46 patients who
possessed a pre-operative vocal recording.
In a blind, randomized comparison, the team detected no voice
breaks in 74 percent of the post-operative sample. Fifteen percent
of the patients still experienced mild voice breaks, four percent
were rated moderate and seven percent considered severe. Breathiness
remained in up to 30 percent of the post-operative patients, but was
rated severe in only six percent.
"The surgery continued to provide long-lasting resolution of
vocal cord spasms and voice breaks in a majority of patients," said
Chhetri. "This suggests the procedure will expand as an important
therapeutic technique for treating spasmodic dysphonia."
"Our next step will be to recruit and study more patients to
better understand how and why the surgery is effective," he added.
"We want to identify what causes spasmodic dysphonia and gain
insights into how the surgical results vary for different people."
Typically appearing between the ages of 30 and 50, spasmodic
dysphonia at first sounds like laryngitis, or a scratchy throat. As
the disorder worsens, patients are rendered nearly mute and left
with a half-broken voice. Many listeners mistake the disorder for
stuttering, a contagious illness or mental incapacity.
People who suffer from spasmodic dysphonia are forced to
surrender the personal opinions that define them as a person.
They're unable to contribute to conversations on work projects,
family, religion, politics and pop culture. Telephone communication
and job interviews become impossible. The difficulties are
especially pronounced in the elderly, whose friends may have
difficulty hearing even without the challenge of interpreting
Chhetri's coauthors included Berke, Bruce Gerratt, Ph.D., Jody
Kreiman, Ph.D., and Abie Mendelsohn, all of the UCLA Division of
Head and Neck Surgery, which funded the research.
Berke has trained surgeons around the world in the surgical
technique, called laryngeal denervation and reinnervation, which is
performed almost exclusively in the United States at UCLA Medical
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