For over a century spastic dysphonia--a disorder of phonation--remained enigmatic and highly resistant to treatment. Recurrent laryngeal nerve surgery provides patients with elimination of their spastic dysphonia symptoms. Maintenance of long-term surgical results has been a problem in some cases. Management of this problem and of problems in the diagnosis and treatment of patients with spastic dysphonia are discussed. The observations and conclusions are based on almost 300 patients examined and/or treated for this disorder.