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Medical Edge Newspaper Column from Mayo Clinic

LARYNGEAL DYSTONIA CAN BE IMPROVED BUT NOT CURED

DEAR MAYO CLINIC: I have a friend who suffers from extreme hoarseness and is barely able to talk. Her doctor performed a flexible laryngoscopy and diagnosed laryngeal dystonia. He told her there was a possibility that her voice could be improved with a certain type of surgery of the larynx, but he didn’t do that type of surgery. What can be done? She’s desperate to improve her voice. — Puyallup, Wash.

ANSWER: First, your friend needs a complete exam to confirm the diagnosis. The medical team would likely include a speech pathologist (a professional with a masters or doctorate degree who evaluates speech and voice disorders); a laryngologist (a medical doctor who specialists in voice disorders); and a neurologist. The exam should include a laryngoscopy with video stroboscopy, where the doctor takes a slow motion video of the fine movements of the vocal cords.

If the evaluation confirms laryngeal dystonia, treatment can improve communication, making the voice sound smoother. However, there is no cure.

Laryngeal dystonia, also called spasmodic dysphonia, is a muscle-movement disorder that causes involuntary muscle spasms in the larynx. Some people with this condition have other muscles disorders, too, causing neck spasms, squinting or tremors. In the larynx, these muscle spasms cause the voice to break up or sound weak, breathy or whispery. (There are three different types of spasmodic dysphonia and the symptoms differ.)

We don’t know exactly what causes spasmodic dysphonia. We do know that it is a disease that occurs in the basal ganglia area of the brain. It can affect anyone, but it’s uncommon in people younger than 30.

Botulinum toxin injections, not surgery, are the most effective treatment for most people with this condition. They have been used to treat spasmodic dysphonia for more than 20 years. During the procedure, a neurologist injects small amounts of botulinum toxin directly into the larynx through the neck. It temporarily weakens the muscles in the larynx, reducing the spasms that interfere with the vocal cords. The therapy typically helps for three or four months and then needs to be repeated.

— Nicolas Maragos, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of spasmodic dysphonia
Appointment Information

READERS: Many women fail to get recommended annual mammograms to detect breast cancer. A busy life or procrastination may be to blame. For other women, misconceptions about mammograms may be holding them back. Mayo Clinic Women’s HealthSource offers some common myths and facts about mammograms.
Myth: Mammograms do more harm than good.

Fact: Mammograms, along with a breast exam by your health care provider, are the best way to detect breast cancer at an early stage. Mammograms often find cancer before a lump can be felt. But they do have limitations. Mammograms miss 10 to 15 percent of breast cancers. Another limitation: Mammograms can result in false positives and show an abnormality that’s mistaken for cancer.

Myth: Mammograms are useless if you have dense breast tissue.

Fact: Spotting breast cancer can be more difficult when breasts contain lots of glandular tissue (dense tissue). A mammogram, however, is not useless. If something looks suspicious but is hard to see with standard mammography, other imaging tests can help determine if cancer is present.

Myth: Radiation from a mammogram can give you cancer.

Fact: Radiation exposure from mammography is small. You receive about the same amount of radiation during a plane trip from New York to California.

Myth: If you don’t have a family history of breast cancer, you don’t need to have a mammogram.

Fact: The majority of breast cancers occur in women who have no known risk factors for the disease.

Myth: Mammograms are too expensive.

Fact: Mammograms generally cost between $100 and $150. Insurance usually pays all or part of the cost. If you don’t have insurance, some state or local programs provide mammograms free or at a low cost. For more information, call Cancer Information Service, 800-422-6237.

Additional Resources:
Mammograms can they find cancer?
New Mammogram Technology

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.