Recurrent Laryngeal Nerve Section for Spastic Dysphonia

Spastic dysphonia is a severe vocal disability in which a person speaks with excessively adducted vocal cords. The resulting weak phonation sounds tight, as if he were being strangled, and has also been described as laryngeal stutter. It is often accompanied by face and neck grimaces. In the past it has been regarded as psychoneurotic in origin and treated with speech therapy and psychotherapy with disappointing results. Because of laboratory and clinical observation that recurrent nerve paralysis retracts the involved vocal cord from the midline, it was proposed that deliberate section of the recurrent nerve would improve the vocal quality of patients with spastic dysphonia. In 34 patients the recurrent nerve was sectioned after Xylocaine® temporary paralysis showed significant improvement in vocal quality. Several patients have been advised against this operation because of the type of voice they developed with one vocal cord temporarily paralyzed. With nerve section plus postoperative speech therapy, approximately half of the patients have returned close to a “normal” but soft phonatory voice. The rest had varying degrees of improvement, but all, so far, have been pleased with the improvement in ease and quality of phonation and reduction or elimination of face and neck grimaces. Two men have a breathy component in their phonatory voices, and one woman has variable pitch.