1
|
Lee JH, Park KN, Lee SW. Efficacy of Botulinum Toxin Injection for Airway Management in Patients with Transient Bilateral Vocal Fold Paresis Following Thyroidectomy: A Prospective Study. J Voice 2024:S0892-1997(24)00109-7. [PMID: 38714437 DOI: 10.1016/j.jvoice.2024.03.032] [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: 02/05/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVES This prospective study evaluated the effectiveness and safety of botulinum toxin injection for airway management in patients with transient bilateral vocal fold paresis (BVFP) after thyroidectomy. STUDY DESIGN Prospective clinical study. METHODS A prospective study was conducted at Soonchunhyang University, Bucheon, Korea, between March 2005 and February 2023. This study enrolled 12 patients with BVFP after thyroidectomy who received botulinum toxin injections into the thyroarytenoid muscles. Vocal fold mobility and airway distress were assessed using a flexible laryngoscope before and after injection. RESULTS Of the 3018 thyroidectomy patients, 12 (0.39%) developed transient BVFP after surgery. Under the guidance of laryngeal electromyography, 3.6 ± 0.6 IU botulinum toxin was administered into the bilateral thyroarytenoid muscles. Notably, nine patients (75%) received a single injection, whereas three (25%) received an additional injection after 7days. The mean time for vocal fold movement recovery was 33.2 ± 17.2days after injection; conventional destructive procedures for BVFP were avoided in 10 of the 12 patients (83.3%). CONCLUSIONS Botulinum toxin injection offers a novel approach to airway management in patients with transient BVFP after thyroidectomy. LEVEL OF EVIDENCE Level 4.
Collapse
Affiliation(s)
- Jae Ha Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Seung-Won Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea.
| |
Collapse
|
2
|
Tibbetts KM, Simpson CB. Adult Bilateral Vocal Fold Paralysis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
3
|
Jackowska J, Sjogren EV, Bartochowska A, Czerniejewska-Wolska H, Piersiala K, Wierzbicka M. Outcomes of CO 2 laser-assisted posterior cordectomy in bilateral vocal cord paralysis in 132 cases. Lasers Med Sci 2018; 33:1115-1121. [PMID: 29557514 PMCID: PMC6004269 DOI: 10.1007/s10103-018-2478-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/06/2018] [Indexed: 11/25/2022]
Abstract
The purpose of the study was to assess the role of laser-assisted posterior cordectomy in the management of patients with bilateral vocal cord paralysis. We aimed an analysis of 132 consecutive patients treated by CO2 laser posterior cordectomy, aged 38-91, 31% tracheotomized on admission. Cordectomy was performed under microlaryngoscopy using CO2 laser (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm, Lumenis Ltd., Yokneam, Israel). We looked at the number of laser glottic procedures necessary to achieve decannulation in tracheotomized patients and to achieve respiratory comfort in non-tracheotomized subjects and we evaluated the two groups for differences in patient characteristics. In tracheotomized patients, we also assessed factors affecting the success of decannulation and we evaluated the impact of tracheotomy on patients' lives. Decannulation was performed in 63% of tracheotomized patients. In terms of the number of procedures, 54% (14), 19% (5), and 27% (7) tracheotomized vs. 74% (61), 24% (20), and 2% (2) non-tracheotomized subjects underwent one, two, or three procedures, respectively. In the group of tracheotomized patients who were successfully decannulated, the number of multiple laser-assisted procedures was significantly higher than in the group of non-tracheotomized subjects with respiratory comfort after treatment (p = 0.04). Advanced age (> 66 years), comorbidities (diabetes, gastroesophageal reflux disease (GERD)), multiple thyroid surgeries, and tracheotomy below the cricoid cartilage were found to decrease the likelihood of successful decannulation. Posterior cordectomy is a simple method allowing for airway improvement and decannulation in patients with bilateral vocal cord paralysis. It is less effective in tracheotomized subjects with diabetes or GERD, older than 66 years old, after two or more thyroidectomies.
Collapse
Affiliation(s)
- Joanna Jackowska
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Elisabeth V Sjogren
- Department of Otolaryngology, Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anna Bartochowska
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland.
| | | | - Krzysztof Piersiala
- Student Research Group at Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Malgorzata Wierzbicka
- Department of Otolaryngology, Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
4
|
Botulinum toxin injection in laryngeal dyspnea. Eur Arch Otorhinolaryngol 2016; 274:909-917. [PMID: 27600559 DOI: 10.1007/s00405-016-4289-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
Data, regarding the use of botulinum toxin (BT-A) in laryngeal dyspnea, are scarce, coming from some cases reports in the literature, including Vocal fold paralysis, laryngeal dystonia, vocal cord dysfunction also called paradoxical motion of the vocal fold (PMVF), and post-neuroleptic laryngeal dyskinesia. There is no consensus regarding the muscles and the doses to inject. The aim of this study is to present a retrospective review of patients treated in our ENT Department by BT-A injection in this indication. This study is a retrospective study describing patients who underwent an injection of botulinum toxin for laryngeal dyspnea in the ENT Department from 2005 to 2015 years. The inclusion criteria were a dyspnea associated with a laryngeal dysfunction, confirmed by flexible fiberoptic nasopharyngolaryngoscopy. Information concerning the causes of the dyspnea, the botulinum toxin BT-A injections procedure, post-injection follow-up, and respiratory outcome were collected for all patients included. In the group of 13 patients included, the main cause identified as principal factor linked with the short breath was: a bilateral VF paralysis (Patel et al., Otolaryngol Head Neck Surg 130:686-689, 7), laryngeal dystonia (Balkissoon and Kenn, Semin Respir Crit Care Med 33:595-605, 2), Anxiety syndrome associated with unilateral vocal fold paralysis or asthma (Marcinow et al., Laryngoscope 124:1425-1430, 3), and an isolated asthma (Zwirner et al., Eur Arch Otorhinolaryngol 254:242-245, 1). Nine out of the thirteen patients were improved by the injections. A BT-A-induced stable benefit for four patients led them to stop the injections in the follow-up. Good outcome was observed in five other patients (main cause: bilateral VP paralysis), allowing a progressive lengthening of the delay between BT-A injections. Four patients did not report a positive risk/benefit ratio after BT-A injections; two of them (with bilateral VF paralysis), because of respiratory side effects and lack of benefit without the side effects for the two others. This failure of effect was not related with BT-A doses injected. This study provides support for using BT-A injections as a symptomatic treatment of periodic laryngeal dyspnea, regardless of the etiologic context. From our data, we suggest that a small starting dose (of around 4 U BT-A Botox®) could be enough for a first injection to obtain a good benefit. The target muscle should be determined by the EMG analysis.
Collapse
|
5
|
Sahin M, Aydogdu I, Akyildiz S, Erdinc M, Ozturk K, Ogut F. Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis. Clin Exp Otorhinolaryngol 2016; 10:193-202. [PMID: 27416735 PMCID: PMC5426387 DOI: 10.21053/ceo.2016.00241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/30/2016] [Accepted: 04/09/2016] [Indexed: 12/01/2022] Open
Abstract
Objectives Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection. Methods Before and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used. Results All patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values. Conclusion After BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.
Collapse
Affiliation(s)
- Mustafa Sahin
- Department of Otolaryngology, Adnan Menderes University Medical School, Aydin, Turkey
| | - Ibrahim Aydogdu
- Department of Neurology, Ege University Medical School, Izmir, Turkey
| | - Serdar Akyildiz
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Munevver Erdinc
- Department Chest Diseases, Ege University Medical School, Izmir, Turkey
| | - Kerem Ozturk
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Fatih Ogut
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| |
Collapse
|
6
|
Benninger MS, Hanick A, Hicks DM. Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series. J Voice 2016; 30:96-9. [DOI: 10.1016/j.jvoice.2015.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/16/2015] [Indexed: 11/25/2022]
|
7
|
Use of botulinum toxin in pediatric otolaryngology and laryngology. Int J Pediatr Otorhinolaryngol 2014; 78:1423-5. [PMID: 25048857 DOI: 10.1016/j.ijporl.2014.06.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 01/20/2023]
Abstract
The use of botulinum toxin in adult otolaryngology has been commonly used in conditions such as spasmodic dysphonia, cricopharyngeal spasm, palatal myoclonus, sialorrhea, and for cosmetic reasons. The current use of botulinum toxin in pediatric otolaryngology and laryngology has primarily been off label and in children older than 2 years of age. This review discusses the different applications of botulinum toxin in pediatric patients and its effectiveness in treating different pediatric conditions.
Collapse
|
8
|
Li Y, Pearce EC, Mainthia R, Athavale SM, Dang J, Ashmead DH, Garrett CG, Rousseau B, Billante CR, Zealear DL. Comparison of ventilation and voice outcomes between unilateral laryngeal pacing and unilateral cordotomy for the treatment of bilateral vocal fold paralysis. ORL J Otorhinolaryngol Relat Spec 2013; 75:68-73. [PMID: 23736349 DOI: 10.1159/000345501] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/29/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Rehabilitation of the bilaterally paralyzed human larynx remains a complex clinical problem. Conventional treatment generally involves surgical enlargement of the compromised airway, but often with resultant dysphonia and risk of aspiration. In this retrospective study, we compared one such treatment, posterior cordotomy, with unilateral laryngeal pacing: reanimation of vocal fold opening by functional electrical stimulation of the posterior cricoarytenoid muscle. METHODS Postoperative peak inspiratory flow (PIF) values and overall voice grade ratings were compared between the two surgical groups, and pre- and postoperative PIF were compared within the pacing group. RESULTS There were 5 patients in the unilateral pacing group and 12 patients in the unilateral cordotomy group. Within the pacing group, postoperative PIF values were significantly improved from preoperative PIF values (p = 0.04) without a significant effect on voice (grade; p = 0.62). Within the pacing group, the mean postoperative PIF value was significantly higher than that in the cordotomy group (p = 0.05). Also, the mean postoperative overall voice grade values in the pacing group were significantly lower (better) than those of the cordotomy group (p = 0.03). CONCLUSION Unilateral pacing appears to be an effective treatment superior to posterior cordotomy with respect to postoperative ventilation and voice outcome measures.
Collapse
Affiliation(s)
- Yike Li
- Department of Otolaryngology, Vanderbilt University, Nashville, TN 37232, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
The role of botulinum toxin in the management of airway compromise due to bilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg 2012; 19:444-8. [PMID: 21986800 DOI: 10.1097/moo.0b013e32834c1e4f] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE OF REVIEW The management of a patient with bilateral vocal fold motion impairment (BVFMI) can be challenging for the otolaryngologist. The treatment traditionally involves tracheotomy, which can be very distressful for some patients. Alternatively, there are endoscopic procedures, which irreversibly sacrifice voice in order to improve airway. The optimal treatment of BVFMI still eludes us. The purpose of this review is to highlight an alternate management strategy for bilateral vocal fold paralysis using botulinum toxin (BTX). This procedure is predicated on the premise that vocal fold immobility is related to synkinetic reinnervation of the vocal fold. Eliminating any thyroarytenoid/lateral cricoarytenoid (LCA) activity during respiratory gestures should allow greater unopposed posterior cricoarytenoid abduction. RECENT FINDINGS There have been several case reports and series, the largest of which involved 11 patients, describing the successful use of BTX for this application. SUMMARY The best candidates for this adductor chemical denervation are those patients who have undergone trauma to the recurrent laryngeal nerve without evidence of cricoarytenoid joint fixation. Patients should have evidence of voluntary thyroarytenoid/LCA laryngeal electromyography activity, though true synkinesis cannot always be reliably identified. The procedure can be another management option for patients with BVFMI.
Collapse
|
10
|
[Intraluminal surgical procedures for glottic enlargement in bilateral vocal fold paralysis in adduction]. Chirurg 2010; 82:116, 118-24. [PMID: 21170510 DOI: 10.1007/s00104-010-1973-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Bilateral vocal fold paralysis with paramedian position of the vocal chords can result from iatrogenic or traumatic nerve injuries, neurologic disorders and extralaryngeal malignancies and usually causes significant shortness of breath while the voice is only slightly affected. Only about 10% of the affected patients tolerate the narrowed airway caused by bilateral vocal fold paralysis in adduction, so most patients are candidates for a surgical intervention. Today, a range of intraluminal surgical procedures for enlargement of the glottis in bilateral vocal fold paralysis have been described which intend to avoid or supersede tracheostomy and which have replaced time-consuming external approaches to the glottis. This report provides an overview of the most important intraluminal surgical procedures for bilateral vocal fold paralysis in adduction and comments in detail on indications, surgical techniques, advantages and potential complications of the presented procedures for temporary or definitive enlargement of the glottis.
Collapse
|
11
|
Ekbom DC, Garrett CG, Yung KC, Johnson FL, Billante CR, Zealear DL, Courey MS. Botulinum toxin injections for new onset bilateral vocal fold motion impairment in adults. Laryngoscope 2010; 120:758-63. [DOI: 10.1002/lary.20821] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|