New Paper Published by Dr. Chang on Spasmodic Dysphonia Treatment in the US

In the May 2009 edition of ENT Journal, Dr. Chang has published a paper titled "A Survey of Current Practices of Physicians Who Treat Adductor Spasmodic Dysphonia in the US." The paper was published online instead of the print magazine and can be read here for free after registration.

The paper reports on a variety of factors considered when treating patients with adductor spasmodic dysphonia including surgery (what kind), botox type (A or B or both), how much botox, what concentration of botox, whether botox that has been frozen is used, etc. Interestingly, though most physicians treat spasmodic dysphonia with botulinum toxin type A, there is great variation in the concentration and amount of botox utilized.

Dr. Chang treats patients with Spasmodic Dysphonia with botox injection every Friday afternoon.

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

Lecture: Dr. Chang to Give Lecture on Spasmodic Dysphonia

Dr. Chang will be giving a talk on spasmodic dysphonia on June 13, 2009 to the Central Virginia SD Support Group in Richmond, VA at the CJW Medical Center Johnston-Willis Campus in the Board Room (1PM - 2PM).

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

Spasmodic Dysphonia Treatment of Northern Virginia

This posting merely serves to provide notice for folks that our practice has been providing Botox injections for spasmodic dysphonia (both adductor and abductor types) since 2005 by Dr. Christopher Chang. We have patients coming from as far away as Norfolk, VA every 3-5 months to obtain this injection for SD relief.

These injections are provided EVERY Friday afternoon (as long as he is not on vacation).

If you have been receiving injections elsewhere and would like to start getting them in our practice, please make an appointment with us as well as bring your entire botox injection history.

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

New Video Uploaded of ABductor Spasmodic Dysphonia

A new video stroboscopy of a patient with ABductor spasmodic dysphonia has been uploaded. Audio of his speech pattern has also been posted. Check it out here.

The direct video link is here.

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

ABC's "Medical Mystery" Will Feature Spasmodic Dysphonia

A story on spasmodic dysphonia will be featured on ABC's "Medical Mysteries" on Tuesday, August 19 at 10 p.m. ET. The show will feature a few celebrities stricken with this rare disorder including National Public Radio host Diane Rehm and cartoonist Scott Adams of Dilbert fame.

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

New ADductor Spasmodic Dysphonia Audio Samples Posted

A patient with a very mild case of ADductor spasmodic dysphonia speaking a variety of phrases has been posted. The nice thing with this case is that only when saying certain "voice-weighted" phrases does the loss of vocal fluency become most apparent. The spasmodic dysphonia can be made less apparent when speaking "voiceless-weighted" phrases. Click here to hear the various audio clips.

As an FYI, the voice-weighted phrases which accentuate ADductor spasmodic dysphonia are as follows:
• Counting from 80 to 89
• "We mow our lawn all year."
• "We eat eels every day."
• "A dog dug a new bone."
• "Where were you one year ago?"
• "We rode along Rhode Island Avenue."
• "Eeee eee eee."

These voiceless-weighted phrases are MUCH easier to say for patients with ADductor spasmodic dysphonia:
• Counting from 60 to 69
• "Peter will keep at the peak."
• "We eat eels every day."
• "When he comes home, we'll feed him."
• "Tap the tip of the cap, please."
• "Keep Tom at the party."
• "See see see."

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

Botox for Spasmodic Dysphonia: Side Effects and Normal Voice

To What Degree Does Botox Dosage Affect Duration of Side Effects and Duration of Normal Voice After Injection for Adductor Spasmodic Dysphonia?

For many patients who suffer from spasmodic dysphonia, botulinum toxin type A or Botox, injection to the vocal cords is a ritual treatment undergone several times a year to keep the spasms in their voice away. The amount of Botox injected varies from patient to patient. Regardless of the patient and their specific dose, it is intuitive to many patients and healthcare providers that larger doses of Botox injected results in greater side effects (breathy/hoarse voice, dysphagia) and perhaps a longer duration of normal voice. This assumption, logical as it may sound, may not be correct according to a new study published in the June 2007 edition of Otolaryngology-Head & Neck Surgery (Link). According to the study’s author Dr. Christopher Chang (Fauquier ENT Consultants, PLC in Warrenton, Virginia) and coauthors, they actually found that there is a bell curve response of normal voice duration to higher doses of Botox. In other words, at some tipping point, giving higher doses of Botox actually resulted in a decrease in duration of normal voice. The study also reported, not surprisingly, that higher doses of Botox does lead to more severe side effects that lasts longer before normal voice resumes. The impact of this finding is that for some patients, a better and longer response may occur with a LOWER dose of botox.

These results were obtained from 101 patients with adductor spasmodic dysphonia who collectively underwent 876 injections between March 1998 and August 2006. In this study population, the Botox dosage range went from as low as 0.25 Units to as high as 7.5 Units bilaterally. The average dose was 1.62 Units. Based on statistical models, the “ideal” dose was found to be 1.41 Units bilaterally which would give a theoretical zero days of side effects and 87.3 days of normal voice. Based on these same statistical models, giving Botox doses higher than 1.41 units bilaterally theoretically would result in a DECREASE in duration of normal voice while increasing the duration and severity of side effects.

Of course, theory doesn’t always play out in reality as many individuals obtain perfectly good results with Botox dosages much larger than 1.41 Units bilaterally. However, when looking over large numbers of patients with spasmodic dysphonia over many injections over time, the statistical models provided in the study does provide some insights into what may be happening inside the body with each Botox injection.

With larger doses of Botox injected, larger volumes are obviously required. With increased volumes injected, however, there is an increased risk of diffusion of the toxin beyond the vocal cord muscle. Such spread of the toxin beyond the vocal cord muscle would result in a decrease in toxin left behind to exert its effect. Another outcome of this diffusion would be increased side effects as other uninvolved muscles become affected by Botox. As an example stated another way, if 4.0 Units were injected into the vocal cord muscle, 1.5 Units may actually diffuse away affecting other muscles in the area causing side effects. This would leave only 2.5 Units (instead of 4.0 Units) behind to actually affect the vocal cord muscle.

What does this information mean? Well, it does suggest strategies to improve clinical efficacy while causing less severe and shorter duration of side effects. How? By using smaller volumes to decrease risk of diffusion. How can one use less volume, but maintain or even increase effective dosage amounts? By distributing a large dose over multiple injections instead of one injection. By using multiple injections, one is effectively using smaller volumes over multiple injection sites, a strategy known as “saturation of injection site”. Such a strategy may result in improved outcomes after Botox injections without resorting to large doses of Botox with its attendant side effects.

Though physicians throughout the world are investigating other experimental treatment options for spasmodic dysphonia such as selective laryngeal nerve denervation reinnervation, thyroarytenoid myectomy, thyroplasty, and carbon dioxide laser ablation, this study does bring to light that the old standard of Botox injection also has much room to become even better. Although the strategies based on this study have yet to be verified in clinical studies, it does bring up the that fact that even something as straightforward and simple as an injection can be further refined and improved upon.

Dr. Chang does provide Botox injections for patients with spasmodic dysphonia every Friday afternoon in Warrenton, Virignia.

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

Original Research By Dr. Chang Published in Peer-Reviewed Otolaryngology Journal

In the June 2007 edition of the journal Otolaryngology-Head & Neck Surgery, Dr. Chang's original research has been published. The title of the paper is "Relationship of botulinum dosage to duration of side effects and normal voice in adductor spasmodic dysphonia." Click here to read the abstract.

Dr. Chang treats patients with spasmodic dysphonia using BOTOX every Friday afternoon. To watch a video of how exactly her performs this procedure in a patient, click here.

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

Article in USA Today on Spasmodic Dysphonia

On January 15, 2007, an article appeared on spasmodic dysphonia in USA Today. Click here to read the article.

Dr. Chang treats patients with spasmodic dysphonia using BOTOX every Friday afternoon. To watch a video of how exactly her performs this procedure in a patient, click here.

---

Books on voice therapy found to be a useful ADJUNCT to botox injections:

Read More

Dr. Chang was recently featured in the Healthy Happenings publication

Pages 1-2: "New ENT Brings Hope to Voice Sufferers". Dr. Chang featured in the article goes over the new skills he will bring to not only Warrenton, Virginia, but mid-Atlantic USA. He is one of only a few surgeons in the US who treats Zenker's Diverticulum endoscopically, treats patients with spasmodic dysphonia, as well as utilizes advanced surgical techniques to correct a hoarse voice. To view the article, click here.

Read More