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| Conflicting diagnoses |  | ||
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Posted by: silental ® 03/25/2010, 10:26:35 |
I was diagnosed with MTD in 2007 by a teaching professor/MD of the otolaryngology department of a highly respected hospital. I then had many sessions of voice therapy with their speech pathologist. After this treatment being unsuccessful, I had Botox injections into the false vocal chords in 2008. I had a good voice for maybe 2 months max. after really having NO voice for the first month, followed by about another month of almost no voice. It was something I didn't want to repeat. However, having the strained voice again, I saw the same doctor again in Oct. 2009. He said he was going to get me setup with a new speech therapist and also schedule me for another Botox surgery. I say surgery, since he does it under a general anesthetic. After 3 months of hearing nothing from him, I am told that this doctor has left to take a position at another hospital out of state. I then get an appointment to see his replacement. She scoped my throat and said she did NOT see MTD and would therefore not feel comfortable doing a repeat of the Botox injections. She referred to a doctor who specializes in Spasmodic Dysphonia at another private facility. Within minutes of just talking to me, he diagnosed me with ADSD. He then scoped me and had me read part of a paragraph, make various sounds at several pitches and volumes for a couple of minutes. Then he played back the video of my vocal chords that he had recorded during these exercises. He then proceeded to tell me he could inject me then and there with Botox. I inquired about the cost and he had a clerical type come in and quote $900 if through an insurance company or $600 if out of pocket. Additionally, THIS initial visit was going to be $900. I’m at the point of paying out of pocket for this treatment but am concerned about how two, supposedly, top doctors in their field could come up with differing diagnoses. Does ADSD sometimes appear to be MTD? |
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Posted by: David Barton ® 03/25/2010, 16:18:21 |
It is notoriously difficult to distinguish between AD/SD and MTD. We have discussed this on the BB before. It is very common to have more than one diagnosis before you arrive at the correct one, but fortunately, and largely due to the work of the NSDA, most patients are now finding diagnosis takes months rather than years. I'm including something I wrote after listening to a presentation on SD vs MTD made by Dr Marshall Smith at an NSDA symposium: ########################################################## Dr Smith discussed the difference between voiced and voiceless sentences. He was talking about how to distinguish between AD/SD and MTD = muscle tension dysphonia or hyperfunctional voice. Try saying these: Voiced sentence: "Early one morning a man and a woman were ambling along on a one mile lane running near Rainy Avenue." Voiceless sentence: "He saw half a shape mystically cross fifty or sixty steps in front of his sister Kathy's house." AD/SD patients struggle with the first sentence but can say the second one fairly easily. In contrast MTD patients have difficulty with both. Many others have been used: Voiced: "Mama made lemon jam". Counting from eighty to ninety Voiceless: "She sells seashells by the sea shore. The puppy bit the tape." Counting sixties. ################################################### I also recall hearing from SD experts that Botox will improve an AD/SD voice but not an MTD voice. If that is correct, and you gained some improvement, then you might want to question the original diagnosis. Of course, the Botox treatment can be fine-tuned in several ways - placement, dose, left cord, right cord or both cords - to improve how long it lasts and minimise the initial breathiness some patients experience. You can discuss that with your doctor(s). Best wishes David Barton (AD/SD, Auckland, NZ)
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Posted by: silental ® 03/25/2010, 19:50:55 |
Thank you David. I tried the sentences and I was able to read the "voiceless" ones fairly well...anyway much easier...so I suppose the ADSD diagnosis is correct. I can't wait to get the next Botox injections. |
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Posted by: Catherine1011 ® 03/25/2010, 21:15:15 |
I have a combination of both which is common. I have mild SD but the muscle tension has taken over to compensate and gotten out of control. I'm trying to relearn how to relax all those muscles but it can take 6-12 months of hard work. I'll let you all know how it goes. |
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Posted by: silental ® 03/29/2010, 19:13:41 |
Catherine, I am interested in the "hard work" you're doing? Can you describe it? I'm asking because nothing the speech therapists I've seen has worked. I'd do ANYTHING to overcome this!!!! Thanks. |
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