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Larsen D, Olejniczak M, Kerevel YP, Adkins L, McWhorter AJ, Kunduk M. Patient-Reported Outcomes after False Vocal Folds Injections for Adductor Spasmodic Dysphonia. J Voice 2024:S0892-1997(24)00156-5. [PMID: 38839465 DOI: 10.1016/j.jvoice.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES The primary objective of this study is to investigate if false vocal folds (FVF) or simultaneous FVF with thyroarytenoid (FVF+TA) Botox® injections achieve comparable treatment effects to standard TA injections. This study also aims to determine how patient-reported outcomes contribute to the transition to, and continuation of, FVF or FVF+TA injections. METHODS Retrospective chart review was performed for all patients receiving Botox® for adductor spasmodic dysphonia at a laryngology practice between 2005 and 2018. Twenty out of 103 patients met the study's inclusion criteria. All subjects began standard treatment with TA injections. Based on response to injection, patients either continued to receive TA injections (group TA; n = 7), switched to FVF injections (group FVF; n = 7), or switched to FVF+TA injections (group FVF+TA; n = 6). A comparison of group means before and after initiation of FVF±TA injections was performed between groups FVF and FVF+TA to group TA for the injection dosage, the duration of injection cycles, the patient-reported duration of best voice, and the presence and duration of breathiness and choking. Within-group observations were also compared before and after FVF±TA injections. RESULTS There were no significant findings for the variables between group FVF and group TA before FVF injections. The duration of injection cycles was significantly shorter for group FVF than group TA after FVF injections (95% CI: -66.05, -0.34; P = 0.05). However, duration of best voice quality, breathiness, and choking were similar (P > 0.05) for group FVF to group TA after FVF injections. Group FVF+TA had a significantly shorter duration of injection cycles (95% CI: -66.97, -3.22; P = 0.03), best voice (95% CI: -0.76, -0.03; P = 0.04), and choking (95% CI: -2.68, 0.02; P = 0.05) than group TA before FVF+TA injections. Group FVF+TA displayed a similar duration (P > 0.05) of injection cycles, best voice quality, breathiness, and choking to group TA after FVF+TA injections. Within-group, increased duration of injection cycles and best voice were observed after FVF±TA injections for both group FVF and FVF+TA. Acute adverse events were variable within groups after FVF±TA injections. CONCLUSION This study compared outcomes of FVF or FVF+TA injections to successive TA injections among patients. FVF injections displayed similar duration of best voice quality, breathiness, and choking to TA injections. FVF+TA injections achieved similar duration of injection cycles, best voice quality, breathiness, and choking to TA injections. This study demonstrates that patients guided by a reduced duration of adverse events, while tolerating a shorter injection cycle, may benefit from initiation and continuation of FVF injections. Patients guided by increased duration of injection cycle and best voice, while tolerating the duration of adverse events, may benefit from initiation and continuation of FVF+TA injections.
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Affiliation(s)
- Deirdre Larsen
- Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana; Our Lady of the Lake, The Voice Center, Baton Rouge, Louisiana
| | - Michael Olejniczak
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Yann P Kerevel
- Department of Political Science, Louisiana State University, Baton Rouge, Louisiana
| | - Lacey Adkins
- Our Lady of the Lake, The Voice Center, Baton Rouge, Louisiana; Department of Otorhinolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Andrew J McWhorter
- Our Lady of the Lake, The Voice Center, Baton Rouge, Louisiana; Department of Otorhinolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Melda Kunduk
- Our Lady of the Lake, The Voice Center, Baton Rouge, Louisiana; Department of Otorhinolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
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Heffernan A, Hu A. Spasmodic Dysphonia Patients' Perception of Pain with Botulinum Toxin Injections. Laryngoscope 2024; 134:240-246. [PMID: 37409790 DOI: 10.1002/lary.30864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To evaluate spasmodic dysphonia patients' perception of pain associated with laryngeal botulinum toxin (BTX) injections and to determine factors associated with higher pain scores relative to other included patients. METHODS Prospective cohort study. Adult patients with adductor spasmodic dysphonia that presented to a tertiary laryngology practice for BTX injections were recruited from March to July 2022. Patients completed the visual analog scale (VAS) pre-procedure to quantify predicted pain. Ten minutes post-procedure they completed VAS and the short form McGill Pain Questionnaire (SF-MPQ). Factors that may affect pain were extracted from charts. Descriptive statistics, univariate, and multivariate analyses were conducted (alpha = 0.05). RESULTS One hundred and nineteen patients were included (63 ± 14 yo, 26% Male). SF-MPQ reported mild pain (4.12 ± 4.05 out of 45) with a pain intensity of none to mild (0.70 ± 0.89 out of 5). Bilateral injections yielded significantly higher SF-MPQ scores (5.19 ± 4.66) than unilateral injections (3.30 ± 3.30) (p = 0.012). There was a significant VAS reduction from pre 28.9 ± 24.6 mm (out of 10 mm) to post 24.5 ± 22.3 (p < 0.001). On multiple regression analyses, receiving a bilateral injection significantly (p < 0.05) contributed to a model that predicted higher pre-VAS (p = 0.013). Bilateral injections (p < 0.05) and higher VHI-10 (p < 0.05) contributed to a model that predicted higher total SF-MPQ (p = 0.001) and affective SF-MPQ (p = 0.001) scores. Not being a professional voice user (PVU) significantly (p < 0.05) contributed to a model that predicted higher post-VAS (p = 0.008) scores. CONCLUSIONS BTX injections were well tolerated with low pain scores. Factors associated with higher relative predicted or experienced pain included bilateral versus unilateral injection, PVU status, and higher VHI-10. LEVEL OF EVIDENCE 4 Laryngoscope, 134:240-246, 2024.
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Affiliation(s)
- Austin Heffernan
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Hu
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Gochman GE, Dwyer CD, Young VN, Rosen CA. Exploring Patient's Preference of Patient-Reported Outcome Measures in Laryngeal Movement Disorders. Laryngoscope 2023; 133:1448-1454. [PMID: 36314426 DOI: 10.1002/lary.30376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Despite many available patient-reported outcome measures (PROMs) for laryngeal movement disorders, there is a lack of patient input regarding which PROM most accurately and conveniently captures aspects related to their vocal disease. This study aimed to assess patients' preferences among a selection of voice-related PROMs (Voice Handicap Index-10 [VHI-10], OMNI-Vocal Effort Scale [OMNI-VES], Communicative Participation Item Bank-General Short Form [CPIB-10], and Visual Analog Scales [VAS]) within the laryngeal movement disorder population and investigate associations between selected instruments. METHODS Prior to botulinum toxin A injection, patients with laryngeal dystonia and/or essential tremor of the vocal tract were administered the VHI-10, OMNI-VES, CPIB-10, and three novel VAS questions in a randomized order. Patients rank ordered the four PROMs based on the PROMs' reflection of their voice problems. Pearson's correlation coefficients evaluated pairwise associations among PROM scores. Fisher's exact test compared the preferred PROM rankings. RESULTS Seventy patients (53 female, mean age = 60.7 years) participated. The VHI-10 and CPIB-10 were most preferred at 33.9% and 27.4% respectively. The OMNI-VES and VAS scales were less favored (19.4%, each). When analyzed by age ≥60 years, the CPIB-10 was most favored (33.3%), but for age <60 years, VHI-10 was most preferred (42.3%). There was a strong correlation between scores of all administered PROMs (strongest correlation between OMNI-VES and VAS, r = 0.8, p < 0.001; the weakest correlation between OMNI-VES and VHI-10, r = 0.6, p < 0.001). CONCLUSIONS With an increasing trend in PROMs usage and a strong correlation between all evaluated outcome instruments, insight regarding patients' PROM preferences is an area for further consideration. LEVEL OF EVIDENCE NA Laryngoscope, 133:1448-1454, 2023.
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Affiliation(s)
- Grant E Gochman
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Christopher D Dwyer
- Division of Otolaryngology, Department of Surgery, Harvard University, Brigham & Women's Hospital, Boston, Massachusetts, U.S.A
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
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Dwyer CD, Gochman GE, Rosen CA, Young VN, Schneider SL. Comparison of Outcome Measures (Subjective, Objective, and Patient-Based) in Laryngeal Dystonia Treatment With Botulinum Toxin A Injection. J Voice 2023:S0892-1997(23)00122-4. [PMID: 37121839 DOI: 10.1016/j.jvoice.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Outcome assessment in laryngeal dystonia is hindered by lack of consensus on a core set of outcome measures to quantify treatment effect and disease severity on quality of life. Potential outcome measure domains include objective voice, clinician reported, and patient reported outcome measures (PROMs) for determining treatment success and longitudinal disease tracking. We aim to determine correlations between a selections of outcome measure tools following Botulinum toxin injection. METHODS A selection of instruments were administered to assess adductor laryngeal dystonia patient outcomes before and after Botulinum toxin injection. Voice samples recorded using a cellular telephone application were used for objective acoustic measures (CPPS, acoustic voice quality index) and speech language pathologist perceptual analysis (CAPE-V). Additionally, patients completed a PROMs battery consisting of the Voice Handicap Index-10, Communicative Participation Item Bank-10, OMNI-Vocal Effort Scale, 3 visual analog scale (VAS) questions. Changes in these outcome measures pre-post treatment were compared between each other and with a global rating of change questionnaire (GRCQ) using Spearman's rank correlation coefficients. RESULTS Twenty six patients (20 female, mean age 57.7 years) participated. Using an anchor based GRCQ, patients reported Botox efficacy was the only outcome measure found to have significant correlation (r = 0.54, P = 0.022); all other outcome measures did not meet statistically significant correlation. Amongst the selected outcome tools, several moderate-strong correlations were identified, largely for outcome measures within the same domain. Most notable were correlations between the patient reported OMNI-VES and VAS questions (r > 0.68, P < 0.05), clinician CAPE-V strain and overall severity (r = 0.900, P < 0.001), and acoustic voice quality index with sustained vowel CPPs (r = -0.797, P = 0.002). CONCLUSION Correlation between outcome measures instruments used for patients with adductor laryngeal dystonia requires further attention. Weak correlations with an anchor based GRCQ were found for this study's selected outcome instruments. A select number of correlations were found between outcome instruments within each of the individual outcome measure domains (patient perception, clinical perception, objective acoustics), but there was largely a lack of correlation found for instruments between these three separate domains.
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Affiliation(s)
- Christopher D Dwyer
- Division of Otolaryngology, Department of Surgery, Harvard University, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Grant E Gochman
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Clark A Rosen
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
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Robotti C, Mozzanica F, Barillari MR, Bono M, Cacioppo G, Dimattia F, Gitto M, Rocca S, Schindler A. Treatment of relapsing functional and organic dysphonia: a narrative literature review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S84-S94. [PMID: 37698105 PMCID: PMC10159638 DOI: 10.14639/0392-100x-suppl.1-43-2023-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 09/13/2023]
Abstract
Information about failure and relapses is critical in deciding whether and how to treat a given condition, as well as during patient counselling before therapy. This paper aims to perform a non-systematic review of relapses and failure of dysphonia treatment in the adult population. Studies on failure and relapses after treatment of benign vocal fold lesions, functional dysphonia and neurogenic dysphonia were analysed. The frequency and the duration of follow-up were heterogeneous, and the management of relapses was reported in only a portion of the studies. Relapses after surgical treatment of benign vocal fold lesions ranged between 1% and 58% of cases, and their management was mainly surgical. Rates of relapse after voice therapy for functional dysphonia and spasmodic dysphonia were 12%-88% and 8%-63%, respectively. Rates of relapse after surgical treatment for unilateral and bilateral vocal fold paralysis were 10%-39% and 6%-25%, respectively; treatment was mainly represented by surgical revision. In conclusion, failure and relapses of functional and organic dysphonias after therapy are not rare, but treatment modalities are seldomly reported. The data from this non-systematic review stresses the need for further research in this area.
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Affiliation(s)
- Carlo Robotti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesco Mozzanica
- Department of Otorhinolaryngology, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, University of “Luigi Vanvitelli”, Naples, Italy
| | - Marcella Bono
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giancarlo Cacioppo
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Francesca Dimattia
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Marco Gitto
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Sara Rocca
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Woo P. Simultaneous Botox and Augmentation Injection Laryngoplasty in Patients With Adductor Spasmodic Dysphonia (ASD) and Tremor. J Voice 2022:S0892-1997(22)00223-5. [PMID: 36050248 DOI: 10.1016/j.jvoice.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although Botulinum Toxin (BOTOX) is effective for adductor spasmodic dysphonia (ASD) and essential vocal tremor (EVT), the side effects of breathy dysphonia may result in reluctance to pursue BOTOX treatment. We sought to improve results in selected elderly tremor patients with EVT and in professional voice users with ASD by simultaneous BOTOX injection and injection laryngoplasty using Hyaluronic acid (HA/Botox). MATERIAL AND METHODS Between July 2018 and March 2022, 23 simultaneous HA/Botox using LEMG control were done in eight patients with ASD and EVT (23 of 406 Botox Injections). All eight patients have previously reported unwanted side effects with poor voice results with Botox. Three patients had tremor with presbyphonia. Injection of Botox is performed first using LEMG control, followed by bilateral LEMG guided injection of 0.1 cc of HA. RESULTS All HA/Botox injections were tolerated well. All patients reported some improved voice. Two patients did not go on to further HA injections while the others six have requested ongoing simultaneous HA/Botox injections. Patients with EVT and presbyphonia noted greater stability of voice than Botox alone. It lasted through the injection cycle. The professional voice users reported less breathy voice that allowed them to work right after the BOTOX injection. CONCLUSION Simultaneous BOTOX injection with injection laryngoplasty using HA may be helpful in patients with tremor and presbyphonia. It also may be considered in professional voice users with ASD to reduce side effects of BOTOX.
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Affiliation(s)
- Peak Woo
- Clinical Professor, Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mt. Sinai, New York, New York.
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Dwyer CD, Leclerc AA, Nandedkar SD, Young VN, Rosen CA. Quantitative laryngeal electromyography parameters may correlate with improved outcomes following botulinum toxin injection for spasmodic dysphonia. Muscle Nerve 2021; 63:525-530. [PMID: 33382480 DOI: 10.1002/mus.27161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite use of qualitative laryngeal electromyography (LEMG) guided botulinum toxin A (BoNT-A) injection for treatment of adductor spasmodic dysphonia (AdSD), unsatisfactory injections and complete "misses" remain problematic. We aimed to determine if the quantitative LEMG measure of number of small segments (NSS) correlates with voice outcomes following (BoNT-A injection for AdSD. METHODS Automated quantitative LEMG analysis was performed during electromyography (EMG) -guided BoNT-A injection into the thyroarytenoid-lateral cricoarytenoid muscle complex for treatment of AdSD. Pre-injection phonatory NSS values were correlated with clinical voice outcomes and patient reported injection results. RESULTS Quantitative LEMG measures were obtained for 45 AdSD patients (28 female, mean age 60.8 ± 12.8 years) during EMG-guided BoNT-A injection. Mean sampled NSS during phonation immediately prior to BoNT-A injection was 524 ± 323 (range: 2-904). Mean follow up was 36.5 ± 9.4 days; one patient was lost to follow-up. In comparison to their previous BoNT-A injection, the current injection was rated as worse, same, and better by 13 (29.5%), 25 (56.8%), and 6 (13.6%) patients, respectively. All 4 (9.1%) patients with NSS < 200 rated their BoNT-A injection result as worse than previous, and change in Voice Handicap Index-10 (VHI-10) scores were worse or without change. CONCLUSIONS Aiming for an NSS value greater than 200 during phonation prior to BoNT-A toxin injection for AdSD may reduce unfavorable voice outcomes.
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Affiliation(s)
- Christopher D Dwyer
- UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Andrée-Anne Leclerc
- Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | | | - VyVy N Young
- UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Clark A Rosen
- UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA
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Zhao K, Guillaud M, Hu A. Factors Associated with Failure of Botulinum Toxin Injection in Adductor Spasmodic Dysphonia. Ann Otol Rhinol Laryngol 2020; 129:996-1002. [DOI: 10.1177/0003489420928373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Electromyography (EMG) Guided botulinum toxin (BTX) injection is considered first-line treatment for adductor spasmodic dysphonia (SD). Failure rate can range between 6% and 29%. Study objective was to determine which factors were associated with failure. Methods: This was a retrospective review conducted at a tertiary, academic center. Adductor SD patients presenting for BTX injections from August 2017 to October 2018 were eligible. Age, gender, Voice Handicap Index (VHI-10), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), number of injections, disease duration, unilateral/bilateral injection, right/left injection, dose quantity, body mass index (BMI), professional voice user, employment, psychiatric comorbidity, breathiness, and dysphagia were investigated. Outcomes included failure as defined by the patient and dosage change. Univariate and multivariate statistical analysis was conducted. Results: Sixty seven out of 564 injections (12%) were categorized as failure by 131 patients. In multivariate analysis, dosage change was associated with shorter duration of good effect ( P < .001), BTX dose ( P = .016), breathiness ( P < .001), bilateral injection ( P = .024), dysphagia ( P = .012) and professional voice user ( P = .021). Failure was associated with first injection with a new physician ( P < .001), professional voice user P < .001) and lack of breathiness ( P = .003). Failure rate was not associated with age, gender, VHI-10, CAPE-V, disease duration, left/right injection, dose quantity, BMI, psychiatric comorbidity, and dysphagia. Conclusion: Failure rate was 12% and associated with patients’ first injection with a physician, professional voice user, and lack of breathiness. Dosage change occurred in 29% of injections and was associated with injection side effects, bilateral injections, BTX dose, professional voice user, and shorter duration of good effect. Level of evidence: 3
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Affiliation(s)
- Kevin Zhao
- Resident, Division of Otolaryngology–Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Martial Guillaud
- Research Scientist, Department Integrative Oncology, BC Cancer, Adjunct Professor Department of Statistics, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Hu
- Laryngologist, Pacific Voice Clinic, Clinical Associate Professor, Division of Otolaryngology-Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
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10
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van Esch BF, Wegner I, Stegeman I, Grolman W. Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients: A Systematic Review. Otolaryngol Head Neck Surg 2016; 156:238-254. [DOI: 10.1177/0194599816675320] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Babette F. van Esch
- Department of Otorhinolaryngology–Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Inge Wegner
- Department of Otorhinolaryngology–Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology–Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Grolman
- Department of Otorhinolaryngology–Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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Payne S, Tisch S, Cole I, Brake H, Rough J, Darveniza P. The clinical spectrum of laryngeal dystonia includes dystonic cough: Observations of a large series. Mov Disord 2014; 29:729-35. [DOI: 10.1002/mds.25865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 02/08/2014] [Accepted: 02/13/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Susannah Payne
- Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Stephen Tisch
- Neurophysiology Department; St. Vincent's Hospital Darlinghurst; Sydney New South Wales Australia
| | - Ian Cole
- Neurophysiology Department; St. Vincent's Hospital Darlinghurst; Sydney New South Wales Australia
| | - Helen Brake
- Neurophysiology Department; St. Vincent's Hospital Darlinghurst; Sydney New South Wales Australia
| | - Judy Rough
- Neurophysiology Department; St. Vincent's Hospital Darlinghurst; Sydney New South Wales Australia
| | - Paul Darveniza
- Neurophysiology Department; St. Vincent's Hospital Darlinghurst; Sydney New South Wales Australia
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Fulmer SL, Merati AL, Blumin JH. Efficacy of laryngeal botulinum toxin injection: comparison of two techniques. Laryngoscope 2011; 121:1924-8. [PMID: 22024846 DOI: 10.1002/lary.21966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 04/13/2011] [Accepted: 04/18/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS It is hypothesized that there is no difference in the effectiveness of botulinum toxin (BTX) injection between electromyography (EMG)-guided and non-EMG guided "point-touch" techniques in the treatment of adductor spasmodic dysphonia. STUDY DESIGN Retrospective chart review. METHODS Patients selected for evaluation underwent sequential treatment by one or both of the senior authors using two different injection techniques with similar BTX dilution and preparation. Data gathered included dose injected, injection effect, and presence and duration of breathiness and dysphagia after injection. Statistical analysis was performed used a generalized estimating equations model. RESULTS A total of 417 injections in 64 patients were analyzed. There was no difference in the rate of successful injections between the EMG-guidance group and the non-EMG guidance group (94.4% and 93.2%, respectively; P = .7). CONCLUSIONS This unique study demonstrates that efficacy of BTX does not necessarily depend on the method of injection used. In experienced hands, excellent clinical results can be achieved with either EMG-guided or non-EMG guided injection techniques.
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Affiliation(s)
- Susan L Fulmer
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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13
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Fulmer SL, Merati AL, Blumin JH. Efficacy of laryngeal botulinum toxin injection: comparison of two techniques. Laryngoscope 2011. [PMID: 22024846 DOI: 10.1002/lary.22316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES/HYPOTHESIS It is hypothesized that there is no difference in the effectiveness of botulinum toxin (BTX) injection between electromyography (EMG)-guided and non-EMG guided "point-touch" techniques in the treatment of adductor spasmodic dysphonia. STUDY DESIGN Retrospective chart review. METHODS Patients selected for evaluation underwent sequential treatment by one or both of the senior authors using two different injection techniques with similar BTX dilution and preparation. Data gathered included dose injected, injection effect, and presence and duration of breathiness and dysphagia after injection. Statistical analysis was performed used a generalized estimating equations model. RESULTS A total of 417 injections in 64 patients were analyzed. There was no difference in the rate of successful injections between the EMG-guidance group and the non-EMG guidance group (94.4% and 93.2%, respectively; P = .7). CONCLUSIONS This unique study demonstrates that efficacy of BTX does not necessarily depend on the method of injection used. In experienced hands, excellent clinical results can be achieved with either EMG-guided or non-EMG guided injection techniques.
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Affiliation(s)
- Susan L Fulmer
- Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Waddell RK. Chiropractic care for a patient with spasmodic dysphonia associated with cervical spine trauma. J Chiropr Med 2011; 4:19-24. [PMID: 19674642 DOI: 10.1016/s0899-3467(07)60108-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2003] [Revised: 06/06/2004] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To discuss the diagnosis and response to treatment of spasmodic dysphonia in a 25-year-old female vocalist following an auto accident. CLINICAL FEATURES The voice disorder and neck pain appeared after the traumatic incident. Examination of the cervical spine revealed moderate pain, muscle spasm and restricted joint motion at C-1 and C-5 on the left side. Cervical range of motion was reduced on left rotation. Bilateral manual muscle testing of the trapezius and sternocleidomastoid muscles, which share innervation with the laryngeal muscles by way of the spinal accessory nerve, were weak on the left side. Pre and post accident voice range profiles (phonetograms) that measure singing voice quality were examined. The pre- and post-accident phonetograms revealed significant reduction in voice intensity and fundamental frequency as measured in decibels and hertz. INTERVENTION AND OUTCOME Low-force chiropractic spinal manipulative therapy to C-1 and C-5 was employed. Following a course of care, the patient's singing voice returned to normal, as well as a resolution of her musculo- skeletal complaints. CONCLUSION It appears that in certain cases, the singing voice can be adversely affected if neck or head trauma is severe enough. This case proposes that trauma with irritation to the cervical spine nerve roots as they communicate with the spinal accessory, and in turn the laryngeal nerves, may be contributory in some functional voice disorders or muscle tension dysphonia.
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Lim ECH, Seet RCS. Botulinum toxin: description of injection techniques and examination of controversies surrounding toxin diffusion. Acta Neurol Scand 2008; 117:73-84. [PMID: 17850405 DOI: 10.1111/j.1600-0404.2007.00931.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The benefits derived from botulinum toxin (BTX) injections may be negated by unintentional weakness of adjacent uninjected muscles. Such weakness may be the result of inaccurate targeting, or diffusion of BTX to surrounding muscles. Several techniques, using electromyographic, endoscopic or imaging guidance are purported to increase the accuracy of targeting. Diffusion of BTX is thought to be influenced by factors such as dose, concentration, injectate volume, number of injections, site and rate of injection, needle gauge, muscle size, muscular fascia, distance of needle tip from the neuromuscular junction, and protein content of the BTX formulation. This article describes techniques that aim to increase the accuracy of BTX injections and examines the controversies surrounding diffusion of BTX following injection.
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Affiliation(s)
- E C-H Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, and National University Hospital, Singapore.
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Hillel AD, Maronian NC, Waugh PF, Robinson L, Klotz DA. Treatment of the interarytenoid muscle with botulinum toxin for laryngeal dystonia. Ann Otol Rhinol Laryngol 2004; 113:341-8. [PMID: 15174759 DOI: 10.1177/000348940411300501] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The treatment of laryngeal dystonia with botulinum toxin has provided various degrees of relief to the majority of patients with adductor dysphonia; however, a significant number of patients have limited or no improvement with this type of therapy. It remains unclear why some patients respond to the routine administration of toxin to the thyroarytenoid muscles whereas others do not. Injections into the lateral cricoarytenoid muscles have provided an improved voice in some patients who were unresponsive to injections into the thyroarytenoid muscles. Fine-wire electromyography can demonstrate the particular dystonic activity of these muscles to help determine which muscle is predominantly involved. It can also demonstrate dramatic dystonic activity in the interarytenoid (IA) muscle in many patients. We present the results of 23 patients treated with injections to the IA muscle after demonstration of dystonic IA activity. Ten have benefited from IA therapy. Five of these 10 patients did not have a good result from botulinum toxin until IA injections were added to the treatment plan. In 8 patients, IA therapy provided no improvement, and 5 patients were lost to adequate follow-up. According to fine-wire electromyography and clinical response, the IA muscle is an active dystonic muscle in some patients with laryngeal dystonia and should be treated with botulinum toxin in selected patients.
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Affiliation(s)
- Allen D Hillel
- Department of Otolaryngology Head and Neck Surgery, University of Washington Medical Center, Box 356515, Seattle, WA 98195-6515, USA
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Abstract
Since the commercial launch of Dysport in 1991, after 10 years of clinical studies on its predecessor formulations, this BTX-A product has shown great therapeutic promise with a good safety profile and low incidence of treatment failures. As with all BTX products, Dysport should not be seen as a generic equivalent but as a specific product with individual unit dosing requirements and side effect profiles. Its role as an important BTX-A molecule looks set to expand as new indications for botulinum toxin arise, and as the cosmetic usage of Dysport is approved in countries outside of South America.
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Affiliation(s)
- Andrew C Markey
- St. John's Institute of Dermatology, St. Thomas' Hospital, London SE17EH, UK.
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Abstract
BACKGROUND The use of botulinum toxin for the treatment of spasmodic dysphonia is currently the treatment of choice for management of this neurological voice disorder. Over the past 20 years, botulinum toxin has been used to treat both adductor and abductor forms of the disorder, with vocal improvement noted after treatment for both. A large number of studies have attempted to document the efficacy of botulinum toxin for improvement of vocal symptoms in individuals with spasmodic dysphonia. OBJECTIVES To determine the effectiveness of botulinum toxin for treating spasmodic dysphonia. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to July 2003), EMBASE (1974 to July 2003 ), CINAHL (through July 2003), Dissertation Abstracts International (1975 to July 2003) and PsycINFO (1975 to July 2003). The search engine FirstSearch was also used (July 2003). Reference lists for all the obtained studies and other review articles were examined for additional studies. SELECTION CRITERIA All studies in which the participants were randomly allocated prior to intervention and in which botulinum toxin was compared to either an alternative treatment, placebo or non-treated control group were included. DATA COLLECTION AND ANALYSIS Two reviewers independently evaluated all potential studies meeting the selection criteria noted above for inclusion. One study met the inclusion criteria and was included in the final analysis. MAIN RESULTS Only one study in the literature met the inclusion criteria. This was the only study identified which reported a treatment/no treatment comparison. It reported significant beneficial effects for fundamental frequency (Fo), Fo Range, spectrographic analysis, independent ratings of voice severity and patient ratings of voice improvement. REVIEWERS' CONCLUSIONS The evidence from randomized controlled trials does not allow firm conclusions to be drawn about the effectiveness of botulinum toxin for all types of spasmodic dysphonia, or for patients with different behavioral or clinical characteristics.
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Affiliation(s)
- C C W Watts
- Department of Speech Pathology & Audiology, University of South Alabama, 2000 University Commons, Mobile, AL 36688, USA.
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