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Clinical Practice: Spasmodic Dysphonia and Vocal Tremor

Department of Communication Sciences and Disorders, University of Iowa
Iowa City, IA

Henry T. Hoffman, MD

Department of Otolaryngology, University of Iowa
Iowa City, IA

Abby L. Hemmerich

Department of Communication Sciences and Disorders, University of Iowa
Iowa City, IA

Douglas J. Van Daele, MD

Department of Otolaryngology, University of Iowa
Iowa City, IA

The Laryngeal Movement Disorder Clinic (LMDC) was started in 1990 in the Department of Otolaryngology at the University of Iowa. This specialized subset of the general Voice Clinic (http://www.healthcare.uiowa.edu/otolaryngology/protocols/Parts/Part1/Part1C/P1C1.htm) is scheduled twice a month for patients with laryngeal movement disorders such as spasmodic dysphonia (SD), vocal tremor, muscle tension dysphonia (MTD), and vocal fold paralysis (VCP). Patients with other craniocervical dystonias also may be seen in this clinic. The purpose of the clinic is to provide specialized diagnostic assessments and treatments. Application of electromyography for diagnosis as well as for directed botulinum toxin injections dominates the practice of this clinic. Voice therapy also is directed through this clinic, with coordination through practitioners in the University of Iowa system or, more commonly, with practitioners who are located closer to the patients' homes. It is the purpose of this article to describe the clinical pathways for patients who are seen at the LMDC from a multidisciplinary perspective. This summary will include aspects of differential diagnosis and clinical history taking, assessment, and treatment for those with laryngeal movement disorders.