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Kunieda C, Nin F, Ohashi T, Hosokawa K, Watanabe Y, Ogawa T, Mori T, Kanazawa T. Botulinum toxin injection for abductor spasmodic dysphonia under cervical ultrasonography guidance. Auris Nasus Larynx 2024; 51:361-364. [PMID: 37838568 DOI: 10.1016/j.anl.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 10/16/2023]
Abstract
Ultrasound (US) imaging effectively provides real-time anatomical information for clinical examinations. In otolaryngology, US imaging can visualize laryngeal muscles as well as cervical muscles. Here we present the case where US imaging was used while injecting botulinum toxin (BT) for the treatment of abductor spasmodic dysphonia, which provided definite results. We could visualize not only the injection pathway but also the infiltration of the BT solution into the posterior cricoarytenoid muscles. Therefore, our laryngeal US imaging is useful for both improving the success rate and avoiding injection complications of BT.
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Affiliation(s)
- Chikako Kunieda
- Department of Otolaryngology, Hashima City Hospital, Gifu, Japan.
| | - Fumiaki Nin
- Department of Otolaryngology, Hashima City Hospital, Gifu, Japan; Division of Biological Principles, Department of Physiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Toshimitsu Ohashi
- Department of Otolaryngology, Hashima City Hospital, Gifu, Japan; Department of Otolaryngology, Head and Neck Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kiyohito Hosokawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Takenori Ogawa
- Department of Otolaryngology, Head and Neck Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tomohiro Mori
- Department of Radiology, Hashima City Hospital, Gifu, Japan
| | - Takeharu Kanazawa
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Leung JS, Rosenbaum A, Holmberg J, Villarroel P, Napolitano C, Badía PI, Lagos-Villaseca A. Improved vocal quality and decreased vocal effort after botulinum toxin treatment for laryngeal dystonia. Auris Nasus Larynx 2024; 51:106-112. [PMID: 37365040 DOI: 10.1016/j.anl.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Laryngeal dystonia (LD) is characterized by irregular and involuntary task-specific spasms of the intrinsic laryngeal muscles. There is no curative treatment for it, however, laryngeal botulinum neurotoxin injections (BoNT-I) are considered the standard of care therapy. This study aims to characterize the population of LD patients and to assess the results of laryngeal BoNT-I. METHODS A Retrospective cohort study was conducted. Medical records were reviewed for all the patients with LD diagnosis seen in the Voice Unit of the Red de Salud UCChristus between January 2013 and October 2021. Biodemographic, clinical and treatment data were collected. Additionally, a telephonic survey was completed by the patients that underwent laryngeal BoNT-I, including self-reported voice outcomes and Voice Handicap Index 10 (VHI-10). RESULTS Of the 34 patients with LD included in the study, 23 received a total of 93 laryngeal BoNT-I and 19 completed the telephone survey. The majority (97%) of the injections corresponded to patients with adductor LD and 3% to abductor LD. Patients received a median of 3 (1-17) injections, with a more frequent cricothyroid approach (94.4%), while the thyrohyoid approach accounted for 5.6% of cases. Most injections were bilateral (96.8%). A significant improvement in the vocal quality and effort was noted after the last injection and the overall BoNT-I treatment (P < 0.001). Similarly, the VHI-10 score improved from a median of 31 (7-40) to 2 (0-19) (P < 0.001) after the last injection. A post-treatment breathy voice was reported in 95% of patients, and dysphagia to liquids and solids in 68% and 21%, respectively. CONCLUSIONS Laryngeal BoNT-I is an effective treatment for LD, achieving an improvement in self-reported vocal quality and VHI-10 scores, and a reduction of the self-reported vocal effort. Adverse effects are mild in the majority of cases, constituting a safe and effective therapy for these patients.
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Affiliation(s)
- Jai-Sen Leung
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Andrés Rosenbaum
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Jorge Holmberg
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Pablo Villarroel
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Carla Napolitano
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Pedro I Badía
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile
| | - Antonia Lagos-Villaseca
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile.
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Sanuki T, Takemoto N. Comparison of Botulinum Toxin Injections and Type 2 Thyroplasty for Adductor Spasmodic Dysphonia. Laryngoscope 2023; 133:3443-3448. [PMID: 37278482 DOI: 10.1002/lary.30806] [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: 03/22/2023] [Revised: 05/01/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Injection of botulinum toxin type A (BTX) into intrinsic laryngeal muscles is the current gold standard therapy for adductor spasmodic dysphonia (AdSD). However, a surgical procedure could potentially offer more stable and long-lasting voice quality to AdSD patients. Here, we report the long-term results of type 2 thyroplasty (TP2) with TITANBRIDGE® (Nobelpharma, Tokyo, Japan) compared with those of BTX injections. METHODS In total, 73 AdSD patients visited our hospital between August 2018 and February 2022. Patients were provided the option of BTX injections or TP2. They were assessed via the Voice Handicap Index (VHI)-10 before treatments and at scheduled clinical follow-ups at 2, 4, 8, and 12 weeks for BTX and at 4, 12, 26, and 52 weeks for TP2. RESULTS Overall, 52 patients selected the BTX injection and had a pre-injection mean VHI-10 score of 27.3 ± 8.8. Following injections, the scores significantly improved to 21.0 ± 11.1, 18.6 ± 11.5, and 19.4 ± 11.7 at 2, 4, and 8 weeks, respectively. There were no significant differences between the pre-injection scores and the 12-week scores (21.5 ± 10.7). Alternately, 32 patients opted to be treated with TP2 and had a pre-treatment mean VHI-10 score of 27.7. All patients reported an improvement in their symptoms. Additionally, the mean VHI-10 score significantly improved to 9.9 ± 7.4 at 52 weeks following treatment. There was a significant difference between the two treatment groups at 12 weeks. Some patients received both treatments. CONCLUSION These preliminary results provide important insights into the value of TP2 as a potential permanent treatment for AdSD patients. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3443-3448, 2023.
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Affiliation(s)
- Tetsuji Sanuki
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoki Takemoto
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Ban MJ, Ryu CH, Woo JH, Lee YC, Lee DK, Kwon M, Hong YT, Lee GJ, Byeon HK, Choi SH, Lee SW. Guidelines for the Use of Botulinum Toxin in Otolaryngology From the Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force. Clin Exp Otorhinolaryngol 2023; 16:291-307. [PMID: 37905325 DOI: 10.21053/ceo.2023.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
The Korean Society of Laryngology, Phoniatrics and Logopedics created a task force to establish clinical practice guidelines for the use of botulinum toxin (BT) in otolaryngology. We selected 10 disease categories: spasmodic dysphonia, essential vocal tremor, vocal fold granuloma, bilateral vocal fold paralysis, Frey's syndrome, sialocele, sialorrhea, cricopharyngeal dysfunction, chronic sialadenitis, and first bite syndrome. To retrieve all relevant papers, we searched the CORE databases with predefined search strategies, including Medline (PubMed), Embase, the Cochrane Library, and KoreaMed. The committee reported 13 final recommendations with detailed evidence profiles. The guidelines are primarily aimed at all clinicians applying BT to the head and neck area. In addition, the guidelines aim to promote an improved understanding of the safe and effective use of BT by policymakers and counselors, as well as in patients scheduled to receive BT injections.
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Affiliation(s)
- Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Joo Hyun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dong Kun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Tae Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Gil Joon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyung Kwon Byeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Won Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Iimura S, Nose Y, Tabata K, Oda K, Yamashita Y, Takahashi N, Kawano Y. Safety and Effectiveness of OnabotulinumtoxinA in Patients with Laryngeal Dystonia: Final Report of a 52-Week, Multicenter Postmarketing Surveillance Study. Toxins (Basel) 2023; 15:553. [PMID: 37755979 PMCID: PMC10537561 DOI: 10.3390/toxins15090553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
This postmarketing surveillance study was conducted to evaluate the safety and effectiveness of onabotulinumtoxinA in Japanese patients with laryngeal dystonia (LD). Patients receiving onabotulinumtoxinA for the first time were enrolled and observed for up to 12 months following the first injection. Safety assessment included adverse drug reactions (ADRs), and effectiveness assessments included the Voice Handicap Index-10 (VHI-10) and physician's global assessment (PGA). ADRs were observed in 48 (5.8%) of 834 patients in the safety analysis set, including dysphonia in 43 (5.2%) patients and dysphagia in 7 (0.8%) patients. The change in total VHI-10 score (mean) in 790 patients included in the effectiveness analysis set showed that improvement in adductor LD peaked at 2 months after the first injection, while patients with abductor or mixed LD showed a gradual attenuation of effect 2-4 weeks post-injection. The change in total VHI-10 score in subsequent injections was generally similar to that following the first injection. The overall effectiveness rate according to the PGA was 93.4% (738/790 patients). The results demonstrate that onabotulinumtoxinA is a well-tolerated and effective treatment for LD in real-world clinical practice.
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Affiliation(s)
- Shigeomi Iimura
- VEO Specialty Care, Value Evidence Outcome, Japan Medical and Development, GlaxoSmithKline K.K., Tokyo 107-0052, Japan; (S.I.); (Y.N.)
| | - Yasuyo Nose
- VEO Specialty Care, Value Evidence Outcome, Japan Medical and Development, GlaxoSmithKline K.K., Tokyo 107-0052, Japan; (S.I.); (Y.N.)
| | - Keiko Tabata
- PMS Data Management, Value Evidence Outcome, Japan Medical and Development, GlaxoSmithKline K.K., Tokyo 107-0052, Japan;
| | - Kenji Oda
- Real World Data Analytics, Value Evidence Outcome, Japan Medical and Development, GlaxoSmithKline K.K., Tokyo 107-0052, Japan;
| | - Yoshiyuki Yamashita
- Specialty Medical Affairs, Japan Medical and Development, GlaxoSmithKline K.K., Tokyo 107-0052, Japan;
| | - Naohiro Takahashi
- PMS, Value Evidence Outcome, Japan Medical and Development, GlaxoSmithKline K.K., Tokyo 107-0052, Japan;
| | - Yoshiaki Kawano
- VEO Specialty Care, Value Evidence Outcome, Japan Medical and Development, GlaxoSmithKline K.K., Tokyo 107-0052, Japan; (S.I.); (Y.N.)
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Sanuki T. Spasmodic dysphonia: An overview of clinical features and treatment options. Auris Nasus Larynx 2023; 50:17-22. [PMID: 35697560 DOI: 10.1016/j.anl.2022.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 05/06/2022] [Accepted: 05/19/2022] [Indexed: 01/28/2023]
Abstract
Spasmodic dysphonia (SD) is considered a rare focal laryngeal dystonia characterized by task-specific voice dysfluency resulting from selective intrinsic laryngeal musculature hyperfunction. Symptoms may be attenuated by a sensory trick. Although SD can be seen at times in generalized dystonia syndrome, it is typically a sporadic phenomenon, and the involvement of the laryngeal adductor muscles is more common than that of the abductor muscles. This research reviews the literature for the pathogenesis, clinical characteristics, treatment options, and current management methods of SD. Technological advances have enabled clinicians to better understand the connection between laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have helped better understand the underlying mechanisms of this neurolaryngology disorder. Currently, the standard of care for SD is the symptomatic management of botulinum toxin (BT) chemodenervation. This is supported by a large body of literature attesting to its efficacy in many different research studies, particularly in the uncomplicated adductor form of the disorder. Efforts towards surgical treatment predate the development of BT treatment by a decade, but the long-term efficacy has not been proven and, further research is expected. Symptom relief in patients with abductor SD and dystonia with tremors after surgical and BT treatments and those in patients remains suboptimal.
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Affiliation(s)
- Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-Cho, Mizuho-Ku, Nagoya, Japan.
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Botulinum Toxin Therapy for Spasmodic Dysphonia in Japan: The History and an Update. Toxins (Basel) 2022; 14:toxins14070451. [PMID: 35878189 PMCID: PMC9319467 DOI: 10.3390/toxins14070451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Spasmodic dysphonia (SD) is a rare neurological disorder that impairs phonatory function by triggering involuntary and intermittent contractions of the intrinsic laryngeal muscles. SD is classified into three types: adductor SD (AdSD), abductor SD (AbSD), and mixed SD. Of these, AdSD accounts for 90–95% of disease; younger females are predominantly affected. Botulinum toxin injection into the laryngeal muscles is safe, minimally invasive, and very effective. Here, we review the history of clinical research for SD conducted in Japan. The first use of botulinum toxin injection therapy to treat SD in Japan was by Kobayashi et al. in 1989. The group developed an objective mora (syllable) method to evaluate SD severity. Recently, we conducted a placebo-controlled, randomized, double-blinded clinical trial of botulinum toxin therapy for AdSD and an open-label trial for AbSD to obtain the approval of such therapy by the Japanese medical insurance system. The mora method revealed significant voice improvement and the evidence was of high quality. Additionally, a clinical trial of type 2 thyroplasty using titanium bridges confirmed the efficacy and safety of such therapy. These studies broadened the SD treatment options and have significantly benefited patients.
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Hyodo M, Asano K, Nagao A, Hirose K, Nakahira M, Yanagida S, Nishizawa N. Botulinum Toxin Therapy: A Series of Clinical Studies on Patients with Spasmodic Dysphonia in Japan. Toxins (Basel) 2021; 13:toxins13120840. [PMID: 34941678 PMCID: PMC8709071 DOI: 10.3390/toxins13120840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Spasmodic dysphonia (SD) is a rare voice disorder caused by involuntary and intermittent spasms of the laryngeal muscles. Both diagnosis and treatment have been controversial. Therefore, a series of clinical studies has recently been conducted in Japan. A nationwide epidemiological survey revealed that adductor SD predominated (90–95% of all cases; 3.5–7.0/100,000), principally among young women in their 20s and 30s. To facilitate early diagnosis, we created diagnostic criteria for SD and a severity grading system. The diagnostic criteria include the principal and accompanying symptoms, clinical findings during phonation, the treatment response, and the differential diagnoses. The severity grade is determined using a combination of subjective and objective assessments. Botulinum toxin (BT) injection is the treatment of choice; however, there have been few high-quality clinical studies and BT has been used off-label. We conducted a placebo-controlled, randomized, double-blinded clinical trial of BT therapy; this was effective and safe. BT treatment is now funded by the Japanese medical insurance scheme. Studies thus far have facilitated early diagnosis and appropriate therapy; they have fostered patient awareness of SD.
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Affiliation(s)
- Masamitsu Hyodo
- Department of Otolaryngology-Head and Neck Surgery, Kochi Medical School, Nankoku 783-8505, Japan; (A.N.); (K.H.)
- Correspondence: ; Tel.: +81-88-880-2393
| | - Kento Asano
- Integrated Center for Advanced Medical Technologies, Kochi Medical School Hospital, Nankoku 783-8505, Japan;
- Department of Medical Innovation, Osaka University Hospital, Suita 565-0871, Japan
| | - Asuka Nagao
- Department of Otolaryngology-Head and Neck Surgery, Kochi Medical School, Nankoku 783-8505, Japan; (A.N.); (K.H.)
| | - Kahori Hirose
- Department of Otolaryngology-Head and Neck Surgery, Kochi Medical School, Nankoku 783-8505, Japan; (A.N.); (K.H.)
| | - Maya Nakahira
- Rehabilitation Department, Kochi Medical School Hospital, Nankoku 783-8505, Japan;
| | - Saori Yanagida
- Department of Communication Disorders, School of Rehabilitation, Health Sciences University of Hokkaido, Tobetsu 061-0293, Japan; (S.Y.); (N.N.)
| | - Noriko Nishizawa
- Department of Communication Disorders, School of Rehabilitation, Health Sciences University of Hokkaido, Tobetsu 061-0293, Japan; (S.Y.); (N.N.)
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Hirose K, Asano K, Sakaguchi M, Nagao A, Nakahira M, Doi N, Kobayashi T, Hyodo M. Post-treatment clinical course following botulinum toxin injection therapy for adductor spasmodic dysphonia: Analysis of data from a placebo-controlled, randomized, double-blinded clinical trial in Japan. Laryngoscope Investig Otolaryngol 2021; 6:1088-1095. [PMID: 34667852 PMCID: PMC8513418 DOI: 10.1002/lio2.669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/22/2021] [Accepted: 09/15/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Botulinum toxin (BT) therapy is a first-line treatment for spasmodic dysphonia (SD). However, a detailed chronological course and clinical factors that affect the therapeutic effect have been vague. In this study, we analyzed the data from our placebo-controlled, randomized, double-blinded parallel-group comparison/open-label clinical trial of BT (Botox) to clarify these. METHODS A total of 22 patients with abductor SD (ADSD) were enrolled. The female-to-male ratio was 20:2 with a mean age of 40.0 ± 10.3 years and a median duration of symptoms of 7.5 years. The therapeutic effect was evaluated based on the change in the number of aberrant morae (phonemes), GRBAS scale, Voice Handicap Index (VHI), and Visual Analogue Scale (VAS). RESULTS The change in the number of aberrant morae peaked at 2 weeks and lasted for 12 weeks in the BT group with significance (P < .01) compared to the placebo group. Objective improvement (number of aberrant morae and [S] element in GRBAS) preceded subjective improvement (VHI and VAS). The change in number of aberrant morae and VHI showed a significant correlation (P < .01). The changes in the number of aberrant morae, VHI, and VAS in younger subjects were greater than in older subjects. Patients who presented with post-treatment breathy hoarseness or dysphagia showed better therapeutic effects. CONCLUSIONS BT therapy was effective for ADSD based on both objective and subjective assessments. Improvements in subjective parameters were delayed compared to objective measures due to post-treatment breathy hoarseness. However, this adverse event was believed to reflect the treatment effect. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Kahori Hirose
- Department of Otolaryngology‐Head and Neck SurgeryKochi Medical SchoolNankokuKochiJapan
| | - Kento Asano
- Integrated Center for Advanced Medical Technologies, Kochi Medical School HospitalNankokuKochiJapan
- Department of Medical InnovationOsaka University HospitalSuitaOsakaJapan
| | - Masahiko Sakaguchi
- Integrated Center for Advanced Medical Technologies, Kochi Medical School HospitalNankokuKochiJapan
- Department of Engineering InformaticsOsaka Electro‐Communication UniversityNeyagawaOsakaJapan
| | - Asuka Nagao
- Department of Otolaryngology‐Head and Neck SurgeryKochi Medical SchoolNankokuKochiJapan
| | - Maya Nakahira
- Rehabilitation DepartmentKochi Medical School HospitalNankokuKochiJapan
| | - Nao Doi
- Rehabilitation DepartmentKochi Medical School HospitalNankokuKochiJapan
| | - Taisuke Kobayashi
- Department of Otolaryngology‐Head and Neck SurgeryKochi Medical SchoolNankokuKochiJapan
| | - Masamitsu Hyodo
- Department of Otolaryngology‐Head and Neck SurgeryKochi Medical SchoolNankokuKochiJapan
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