506 - Tongue Dystonia Causing Dysarthria in a Professional Singer After Viral Upper Respiratory Infection

A 33-year-old professional singer developed focal lingual dystonia four weeks after a severe viral upper respiratory infection. She presented with involuntary tongue contractions producing dysarthria and impaired phonation. Neurologic examination showed task-specific dystonia isolated to intrinsic tongue muscles. Brain MRI and metabolic/autoimmune panels were normal.

Case Description:

Conservative therapy with oral anticholinergics failed. Ultrasound-guided botulinum toxin injections were administered to the genioglossus and intrinsic tongue muscles, paired with specialized speech and orofacial motor therapy. Injections were carefully dosed to preserve swallowing and airway safety. Over 12 weeks she regained normal articulation and resumed professional performance.

Discussions:

Post-infectious focal dystonia is rare and can be career-ending in vocalists. Precise ultrasound guidance enabled targeted chemodenervation, limiting toxin spread and optimizing functional outcomes. Collaboration between neurology, physiatry, and speech therapy was essential for rapid recovery and safe return to high-level vocal activity.

Conclusions:

Lingual dystonia triggered by viral infection should be considered in singers with sudden articulatory deficits. Ultrasound-guided botulinum toxin combined with structured rehabilitation offers an effective, safe treatment to restore professional voice function.