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Objective: To determine the durability of current titanium implants (TI) used in voice improvement surgery for adductor spasmodic dysphonia (ADSD), which is type II thyroplasty (T2T), and identify the effects of their fractures on vocal functions., Methods: A total of 36 ADSD patients who underwent T2T had the following exams: The CT scans of the larynx were performed 1 year after the surgery to assess the fractures of TI. The improvement in the mean voice handicap index 10 (VHI-10) scores and the success rate between nonfractured (NFR) and fractured (FR) groups were compared., Results: It was indicated that TI was broken in 21 cases (58.3%). In one case (2.7%), a fracture on the part of the bridge that connects both sides of the plates was observed, and fractures at holes placed on the plates in the other 35 cases (55.6%). The mean VHI-10 score improved from 27.2 ± 8.1 to 11.4 ± 7.9 in the NFR group and from 26.3 ± 4.9 to 9.7 ± 7.9 in the FR group. The success rates were 66.6% in the NFR group and 71.5% in the FR group. No statistical difference was observed in the improvement in the mean VHI-10 scores, and the success rate between the two groups. However, two cases resulted in failure in the FR group, whereas no worsened case was observed in the NFR group., Conclusion: The current TI used in T2T has low durability and could result in the worsening of vocal symptoms after the surgery., Level of Evidence: 4 Laryngoscope, 133:3028-3033, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Spasmodic dysphonia (SD) is characterized by an involuntary laryngeal muscle spasm during vocalization. Previous studies measured brain activation during voice production and suggested that SD arises from abnormal sensorimotor integration involving the sensorimotor cortex. However, it remains unclear whether this abnormal sensorimotor activation merely reflects neural activation produced by abnormal vocalization. To identify the specific neural correlates of SD, we used a sound discrimination task without overt vocalization to compare neural activation between 11 patients with SD and healthy participants. Participants underwent functional MRI during a two-alternative judgment task for auditory stimuli, which could be modal or falsetto voice. Since vocalization in falsetto is intact in SD, we predicted that neural activation during speech perception would differ between the two groups only for modal voice and not for falsetto voice. Group-by-stimulus interaction was observed in the left sensorimotor cortex and thalamus, suggesting that voice perception activates different neural systems between the two groups. Moreover, the sensorimotor signals positively correlated with disease severity of SD, and classified the two groups with 73% accuracy in linear discriminant analysis. Thus, the sensorimotor cortex and thalamus play a central role in SD pathophysiology and sensorimotor signals can be a new biomarker for SD diagnosis.