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Laryngoscope. 2018 Jan;128(1):177-183. doi: 10.1002/lary.26655. Epub 2017 May 23.

Central voice production and pathophysiology of spasmodic dysphonia.

Author information

1
Maimonides Medical Center, Voice and Swallowing Disorders, Division of Otolaryngology-Head and Neck Surgery, Brooklyn.
2
Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
3
Department of Otolaryngology-Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
4
New York Center for Voice and Swallowing Disorders, New York, New York, U.S.A.

Abstract

OBJECTIVE:

Our ability to speak is complex, and the role of the central nervous system in controlling speech production is often overlooked in the field of otolaryngology. In this brief review, we present an integrated overview of speech production with a focus on the role of central nervous system. The role of central control of voice production is then further discussed in relation to the potential pathophysiology of spasmodic dysphonia (SD).

DATA SOURCES:

Peer-review articles on central laryngeal control and SD were identified from PUBMED search. Selected articles were augmented with designated relevant publications.

REVIEW METHODS:

Publications that discussed central and peripheral nervous system control of voice production and the central pathophysiology of laryngeal dystonia were chosen.

RESULTS:

Our ability to speak is regulated by specialized complex mechanisms coordinated by high-level cortical signaling, brainstem reflexes, peripheral nerves, muscles, and mucosal actions. Recent studies suggest that SD results from a primary central disturbance associated with dysfunction at our highest levels of central voice control. The efficacy of botulinum toxin in treating SD may not be limited solely to its local effect on laryngeal muscles and also may modulate the disorder at the level of the central nervous system.

CONCLUSION:

Future therapeutic options that target the central nervous system may help modulate the underlying disorder in SD and allow clinicians to better understand the principal pathophysiology.

LEVEL OF EVIDENCE:

NA.Laryngoscope, 128:177-183, 2018.

KEYWORDS:

Laryngeal motor cortex; botulinum toxin; laryngeal dystonia; phonation; spasmodic dysphonia; voice

PMID:
28543038
PMCID:
PMC5700869
DOI:
10.1002/lary.26655
[Indexed for MEDLINE]
Free PMC Article

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