Spasmodic dysphonia (SD) is a focal dystonia of the laryngeal musculature. Previously considered to be a rare disorder, it has more recently been suggested that SD is in fact not rare but is frequently misdiagnosed or undiagnosed. This paper would appear to provide further evidence in support of the latter viewpoint. One-hundred-and-seven patients with SD managed at the Emory University Voice Center in Atlanta, Georgia were surveyed about their experiences with the condition. Of the study population, 80% were female with an average age of symptom onset of 45 years.

A delay in diagnosis was a common experience – it took this cohort on average over four years (53.2 months) to be diagnosed with SD after first going to a physician with vocal symptoms.

Furthermore, patients consulted with four different physicians before receiving the correct diagnosis. Over 30% of patients were initially prescribed a medication other than botulinum toxin to treat their symptoms, including 15.6% of patients who were prescribed anxiolytics and 9.4% who were prescribed acid reflux medication. Two major factors that hinder the early diagnosis of SD are the lack of objective diagnostic criteria and the absence of a specific diagnostic test. Until these issues are addressed, the authors argue that earlier diagnosis of this condition requires greater clinician awareness of the typical presenting features of spasmodic dysphonia at both primary and secondary care levels. One potentially helpful clue identified in this study may be the presence of a pre-existing extra-laryngeal dystonia – nearly a quarter of the study cohort reported a second dystonia other than SD, with cervical dystonia being the most common; 2.6% reported having writer’s cramp.

Diagnostic delays in spasmodic dysphonia: a call for clinician education.
Creighton FX, Hapner E, Klein A, et al.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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