Re: ab dystonia
Harriet - "AB" stands for "abductor" SD. It is the more rare form of SD, where the vocal cords spasm apart. "AD" SD is adductor SD. That is where the vocal cords spasm together. Hope that helps! I wish you well, Robin (AB/So. Calif.) --modified by Robin Stull at Fri, Mar 01, 2002, 02:19:32
Re: ab dystonia
Hi HarrietThe difference between ABductor (AB) SD and ADductor (AD) SD is explained at this link: http://www.dysphonia.org/nsda/spasmodic/symptons.asp To put it very simply, with AB/SD the vocal cords open too much, causing loss of voice in places when trying to speak, whereas in AD/SD the vocal cords close together inappropriately, cutting off the voice. David Barton (AD/SD, Auckland, New Zealand)
--modified by David Barton (NZ) at Fri, Mar 01, 2002, 04:26:04
Re: ab dystonia
Thank's for asking that question... Although I knew there were two types, I never new which one I had. Mine was diagnosed as Tension Dysphonia. I remember from the video they took of my vocal chords that the folds were inlarged, in turn blocking my speech... I would assume then, that I have the adductor type????Larry
Southern Ca/ad? sd
Re: ab dystonia
To clarify this - there is no actual change in the vocal cords themselves - it's not a case of them being too large, or too small.The problems is in the "operation" of the vocal cords - in ABductor SD the cords open too much at inappropriate times, with ADductor SD the cords close too much at inappropriate times. Thus therapies/treatment for AD SD, for example, are based on trying to prevent this over-closure, or "hyper-adduction". Botox, for example, achieves this by inducing a semi-paralysis of one or both cords, preventing the spasms or closures of AD/SD. David Barton (AD/SD, Auckland, New Zealand)
--modified by David Barton (NZ) at Fri, Mar 01, 2002, 18:38:58
Re: ab dystonia
I think the best way to describe how we produce speech is like this:
The muscles that move the vocal cords are smooth muscle tissue, also called involuntary muscle and they make their movement without any conscious effort. There are several sets of muscles that act with or oppose each other; the adductors, such as the cricothyroids, pull the cords tight to close them, and the abductors, such as the thyroarytenoids and the cricoarytenoids separate and lessen the tension on the cords. In both cases the muscles do their work by contracting, even though it seems almost paradoxical that the vocal cords relax when the abductor muscles contract. The cords themselves are just tough connective tissue (similar to ligaments and tendons) that have a bit of elasticity to them and when the adductors pull them taut, they close together, just like when you stretch a rubber band.
In adductor SD, the muscles that close the cords become jerky with inappropriate excessive contractions and the cords come together too tightly and for too long. In abductor SD, the muscles that relax the cords contract too much, so the cords stay open longer than they should.
Botox only affects the muscle its injected into, putting it "to sleep" so to speak. The affected muscle then cannot "overcontrol" the vocal cords... in a good case scenario, the vocal cords are able to react in a more normal fashion.
Muscles do their work by signal commands they get from the brain, via nerves. Every muscle fiber receives 2 types of signals... one to contract and then one to relax, in rapid-fire order, over and over. In skeletal muscles (3 types of muscles... skeletal, smooth, and cardiac), you can produce (in the lab) excessive contractions by antagonizing the muscle to contract faster than it has time to relax.. the muscle starts to spasm in tetany. I personally do not know if smooth muscle spasms result from a similar signalling screw-up.
Re: ab dystonia
Hi Susan. I'm not sure about the accuracy of some of the information you posted. It is my understanding that the thyroarytenoid (TA) muscles (which you listed as abductor muscles) are instead the "adductor" muscles. These are the muscles most commonly injected in Adductor SD. And as far as I know the cricothyroid muscles (which you listed as adductor muscles) have more to do with pitch regulation and are not usually involved SD treatment. The cricoarytenoids, as you stated, are abductor muscles. In some cases, the posterior cricoarytenoid (PCA)is injected for Abductor SD. -Laurie
--modified by Laurie at Fri, Mar 01, 2002, 19:38:38
Re: ab dystonia
Hi Laurie. Thanks for the info. It sure seems nothing is simple, and all the muscles interact and affect the action of the other muscles. The thyroarytenoids (TA) definitely have as their main action the job of relaxing the vocal cords, and the cricothyroids (CT) tense the cords. the Lateral cricoarytenoid is the muscle that adducts the cords, and if it spasms, the air-way closes. And the Posterior Cricoarytenoid opens, or abducts the cords.
It's interesting what you said about pitch regulation and the CTs... part of the Botox injection experiments for my combo AB/AD SD involved injecting the CTs bilaterally, but now I'm wondering if that was more for the tremor aspect of my voice (although I've also had my TAs injected, and that did a great job of eliminating the tremor).
It sounds like (and I'm just guessing) injecting the TAs for AD SD might work like this... if you inject the TA muscle to prevent it from relaxing the cords, then the cords stay more taut, and it makes it harder for the lateral cricoarytenoids to close the cords completely during the spasms. When people say they have a higher pitched "mickey mouse" voice after Botox, that would make sense, since the cords remain more taut than normal.It would be nice to have a physiologist provide an exact description of how all these muscles interact. Anybody know a physiologist with a specific expertise in larynx mechanics???
Re: ab dystonia
Thank's for the explanations.... Now I am really confused :-)
Would mine still be the adductor type?? If I recall it was explained like this... The muscles or false vocal chords in front of my actual vocal chords were blocking or interfering, not allowing sounds to resonate properly??? I thought it was said that they were enlarged. Primarily from me straining my voice...Larry
Southern Ca/TD?
Re: ab dystonia
Larry,By your own description, it *sounds like* you do not have either form of Spasmodic Dysphonia (AD or AB). It seems like you are describing Muscle Tension Dysphonia (MTD). You can get a good deal of information on this BB about MTD (and the differences between SD and MTD) by doing a SEARCH-BB on "MTD" as well as accessing the Wake Forest University Center for Voice Disorders site. URL included. MTD is a "dysphonia" but not a "dystonia." Good luck. It's pretty difficult to get treatment unless you know what you have. Hope this helps alleviate confusion. --Lynne (AD-SD; Northern California)
Related link: http://www.wfubmc.edu/voice/
Re: ab dystonia
Lynne,
Thanks for the clarification... My ENT said I had Spasmodic Dysphonia, but after being seen at the USC Medical Center here in LA by Dr. Sinha and a speech and language pathologist named Daniel Kempler, I was diagnost with Tension Dysphonia? I had about eight weeks of Speech Therapy which didn't really help, a whole lot... You have to work at it, and I didn't have good results. I got a second opinion on the advice of my ENT, Dr. Norman J. Harris. I saw Dr. Roger L. Crumley at UCI Medical Center. They were suggesting Botox injections.. My insurance would not cover this, so I have pretty much put that Idea on hold for now. I have been following closely the opinions here on the bulletin board in regards to botox. I have changed my Health insurance this year to Kaiser. I have a new GP and he has scheduled me an appointment to see another ENT. My new GP said he has seen only one other person with this condition. He is in to Computers, so I sent him the link to the Bulletin Board, so that he might get a better insight to this type of condition. I will see the ENT on Thursday.... I really think my best bet is some kind of voice training... I thought Dr. Coopers book was interesting, and have talked to some of his patients about speech Rehabilitation.Thanks again for your help,
Larry
La Mirada, CA/MTD?
Re: ab dystonia (MTD and all kinds of other challenges)
Larry,Any way you can get to the Arizona SD-Symposium this coming Friday and Saturday? You may figure out what is going on with you... if you could make it to the Symposium. Hey, I'm driving through SoCal Wednesday afternoon (two days from now). You could make it...seriously. It's not that far for you and you'd learn so much. It costs $25 and is worth a million in support and knowledge about vocal disorders. This post from you is incredible. It brings up so many issues. Such as: issues of doctors (unless they are experts) not understanding the differences in various dysphonias and the *mixed-messages* you seem to be getting. A Personal Story to Illustrate: I spent 4 years not able to talk at all (suddenly) and doing a ton of research in various libraries on the subject of *voice.* That entire time, I was going to speech therapists and ENT's (within an HMO which I will not name but it is reflected in your post and starts with a "K"). After years of research and thinking I may have everything from aphasia to Parkinson's to a stroke to *whatever*...I finally stumbled on a description of SD. This is prior to the Internet. AND, when I stumbled upon that possibility, I confronted my *K* specialists and ~~ you know what they said? They said, "No, absolutely not. You have some sort of dysphonia but definitely NOT Spasmodic Dysphonia." Huh? I changed my insurance company after that (away from *K*) and finally found a doctor (PCP) who listened to me FOR ONE MINUTE and said, "you have Spasmodic Dysphonia." Yeh right. Duh! I'd been trying to tell the *K* people that for almost a year, after seeing them for three years, and those "experts" could not get it!! When I was finally diagnosed by someone who had been working seriously with SD-patients for 20 years, he said my case was "classic and very severe." He even said, *what took you so long???* to get treatment. I guess the answer to that question is "stupid professionals and people who don't listen or care." As you can tell, this whole issue enfuriates me. Alot of what you say reminds me of another patient who has been run around recently. Write me on private e-mail please. --Lynne
Re: ab dystonia
Larry, If you are beginning to or have been frustrated wait to you keep going with Kaiser. I have Kaiser, and they will do absolutely nothing!
My husband who is primary, says we are changing when open season starts. But even so, I just wanted a good diagnosis, I did get that with Kaiser, I really have not heard of anyone having really good results with BOTOX, who has AB/sd, and that is what I have so I would not even worry about whether it was covered or not. What I am concerned about and can't get them to budge on, is the fact that there is a familial history of Parkinson's disease in my family, both my aunts had it also spinal neuralgias, so I would like to get a brain scan, but they will not to it, however it has been recommended that I have and MRI of neck for my neck pain.Which brings me to all of you or anyone on the board that reads this since we are talking about insurance, What do people have and do they think they have good luck with getting treatment? Jean AB/sd
Virginia
Re: ab dystonia
Larry, I also had a difficult time getting a diagnosis at first. The first ENT I saw said it was allergies, but treatment didn't improve it. The second ENT I saw said it was "bad habits" I had formed using my false vocal cords. When I asked him about SD he said "absolutely not". I think that was because he had only seen 2 cases of SD and they were both AD so he just wasn't thinking about ABSD. Anyway, after I saw him again and he finally diagnosed SD I did get a referral to see an out-of-network doctor (Maragos at Mayo Clinic) because there was no one in my HMO who had experience treating ABSD. Granted, I work in my PCP's office so I can stay on top of things a little easier, but it's worth a try for anyone in an HMO who can't get a satisfactory diagnosis to try an out-of-network referral. Do whatever you have to do to get help! This is too frustrating and life-altering as it is without being unable to get even a diagnosis! I wish you the best! Vicki
Re: HMO's & out-of-network referrals
Just logging in my experience. I also have an HMO and was able, after learning how, to get an out-of-network referral.
Re: Larry
Dear Larry:Just to let you know, I also was diagnosed (with AB SD) by Daniel Kempler and Dr. Sinha. Mr. Kempler spent a good amount of time with me after the referral just talking about SD - very nice of him to do. Who did you have your speech therapy with? When I was interested into looking at the treatment options, I chose to get my out-of-network referral to Dr. Berke at UCLA. I had met a few patients of Dr. Berke's, and of course he is referenced on this BB because of the AD surgery he developed. Did you know there is an Orange County support group? We will be meeting next on Saturday, March 16 from 10am-12 noon down in Fountain Valley. If you want more information, please email me (and know that I'll be off-line from Friday-Monday because I'm going to the Phoenix symposium!) I have heard about a few frustrations with Kaiser from OC support group members - but I also seem to remember that there was a Kaiser SD "expert" in the La Mirada area. Not positive about my facts here. I wish you well, Robin (AB/So. Calif.)
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