1
|
Heyes R, Adler CH, Yee C, Lott DG, Karle WE. Analgesia in Transcutaneous Laryngeal Botulinum Toxin Injections: A Randomized Crossover Trial. Laryngoscope 2024; 134:2277-2281. [PMID: 38157199 DOI: 10.1002/lary.31208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/25/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES There is an absence of data in the literature regarding methods to improve the patient experience during the performance of awake in-office laryngeal injections. This study sought to evaluate whether the use of local anesthetic or a vibrating instrument decreased overall pain experienced by patients with laryngeal dystonia, frequently referred to as spasmodic dysphonia (SD), undergoing transcervical botulinum toxin injections. METHODS This was an unblinded, prospective randomized control trial with a crossover design where each patient received transcutaneous transcricothyroid injection of botulinum toxin with alternating use of no anesthesia, local anesthesia (2% lidocaine in 1:100,000 epinephrine), and vibrating instrument in three consecutive laryngeal injections to treat adductor SD. Patients were randomized to the order they received these treatments. Patients measured pain on a 0-10 visual analogue scale (VAS) and selected their preferred technique after receiving all three analgesic modalities. RESULTS Thirty-two patients completed the study. There was no statistically significant difference in pain between the three analgesic techniques (p = 0.38). The most preferred analgesic technique was the vibrating wand (44% (14/32)). Lidocaine was the second most preferred (37% (12/32)) and 19% (6/32) of patients preferred nothing. When combining the wand and nothing groups, 63% of patients preferred one of these two methods (95% exact CI: 44%-79%). CONCLUSION There was no statistically significant difference in median pain experienced by patients during laryngeal botulinum toxin injection between these different analgesic modalities. More than half of the patients selected a preference for a technique that did not include lidocaine. This data supports individualization of analgesia during transcutaneous laryngeal injections. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2277-2281, 2024.
Collapse
Affiliation(s)
- Richard Heyes
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Charles H Adler
- Department of Neurology, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - Claire Yee
- Department of Biostatistics and Bioinformatics, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - David G Lott
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
| | - William E Karle
- Department of Otolaryngology, Northwell, New Hyde Park, NY, U.S.A
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
3
|
Schnell M, Slavin D. Intensive Voice Treatment following Botulinum Neurotoxin Injection for a Speaker with Abductor Laryngeal Dystonia: An Exploratory Case Study. Semin Speech Lang 2024; 45:137-151. [PMID: 38417816 PMCID: PMC10957285 DOI: 10.1055/s-0044-1779509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Abductor laryngeal dystonia (ABLD) is a rare neurological voice disorder which results in sporadic opening of the vocal folds during speech. Etiology is unknown, and to date there is no identified effective behavioral treatment for it. It is hypothesized that LSVT LOUD®, which was developed to treat dysphonia secondary to Parkinson's disease, may have application to speakers with ABLD to improve outcomes beyond that with botulinum neurotoxin (BoNT) treatment alone. The participant received one injection of BoNT in each vocal fold 2 to 3 months prior to initiating intensive voice therapy via teletherapy. Objective measures of vocal loudness (dB sound pressure level), maximum phonation time, and high/low pitch frequency (Hz) were recorded in all treatment sessions and follow-up sessions. Over the course of treatment, the participant showed steady gains in phonation time, volume, pitch range, and vocal quality with a substantial reduction in aphonic voice breaks by the end of the treatment program. Perceptual symptoms of ABLD were nearly undetectable by the participant and the clinicians up to 12 months posttreatment, with no additional BoNT injections. The results suggest that LSVT LOUD® following BoNT was effective, with long-lasting improvement in vocal function, for this speaker with ABLD.
Collapse
Affiliation(s)
- Mindy Schnell
- Department of Communication Sciences and Disorders, Long Island University, Post, Greenvale, New York
| | - Dianne Slavin
- Department of Communication Sciences and Disorders, Long Island University, Post, Greenvale, New York
| |
Collapse
|
4
|
Liu Y, Chen F, Liang F, Wang C, Chen D, Zhou J, Zhang L, Xiao X, He R, Tang L, Tian L, Zhou L. Comparison of the efficacy and adverse effects of unilateral or bilateral botulinum toxin injections for adductor spasmodic dysphonia: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:1357-1369. [PMID: 38095707 PMCID: PMC10858140 DOI: 10.1007/s00405-023-08366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/19/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE This study aims to aggregate and analyze existing clinical evidence to compare the efficacy and adverse effects of unilateral or bilateral botulinum toxin injections for the treatment of adductor spasmodic dysphonia (ADSD). METHODS Reports from non-randomized controlled trials and cohort studies pertaining to the efficacy and adverse effects of unilateral and bilateral botulinum toxin injections for ADSD were identified and retrieved from four electronic databases from inception to July 2023. The meta-analysis employed fixed or random effects models to assess pooled relative risks (RR), mean differences (MDs), and standard mean differences (SMDs) with their corresponding 95% confidence intervals (CIs). RESULTS We included two non-randomized controlled trials and seven cohort studies comprising 854 total patients. Meta-analysis of the included studies showed that bilateral botulinum toxin injections associated with a longer duration of vocal improvement (MD = - 2.89, 95% CI - 3.13 to - 2.65, I2 = 0%, P < 0.00001). However, bilateral botulinum toxin injections associated with an increase in adverse effects, including a longer duration of breathy voice quality (SMD = - 0.51, 95% CI - 0.79 to - 0.22, I2 = 35%, P = 0.0005) and a higher occurrence of swallowing difficulties (RR = 0.46, 95% CI 0.35 to 0.11, I2 = 0%, P < 0.00001). CONCLUSION Bilateral botulinum toxin injections for ADSD showed a longer duration of vocal improvement, a longer breathy voice duration and a higher dysphagia occurrence and duration than unilateral injections.
Collapse
Affiliation(s)
- Yuyin Liu
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Feifei Chen
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Fangqi Liang
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Can Wang
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Dan Chen
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Jing Zhou
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Lu Zhang
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Xiao Xiao
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Ronghua He
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Li Tang
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Li Tian
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China
| | - Li Zhou
- Department of Otorhinolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Chengdu, 610072, Sichuan Province, People's Republic of China.
| |
Collapse
|
5
|
Lechien JR, Carroll TL, Nowak G, Huet K, Harmegnies B, Lechien A, Horoi M, Dequanter D, Bon SDL, Saussez S, Hans S, Rodriguez A. Impact of Acid, Weakly Acid and Alkaline Laryngopharyngeal Reflux on Voice Quality. J Voice 2024; 38:479-486. [PMID: 34702613 DOI: 10.1016/j.jvoice.2021.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To analyze pre to posttreatment voice changes regarding the type of reflux in patients with acid, weakly acid or alkaline laryngopharyngeal reflux (LPR). METHODS Patients with LPR, diagnosed using hypopharyngeal-esophageal multichannel intraluminal impedance pH-monitoring (HEMII-pH), were prospectively recruited from three University Hospitals. Patients were treated with a combination of diet, proton pump inhibitors, magaldrate and alginate for 3 months. The following clinical and voice quality outcomes were studied pre to posttreatment according to the type of reflux (acid, weakly acid, nonacid): HEMII-pH, gastrointestinal endoscopy features, reflux symptom score (RSS), reflux sign assessment (RSA), voice handicap index (VHI), perceptual voice assessment (grade of dysphonia and roughness), aerodynamic and acoustic measurements. RESULTS From December 2018 to March 2021, 160 patients completed the evaluations, accounting for 60 acid, 52 weakly acid, and 48 alkaline cases of LPR. There were no baseline differences in clinical and voice quality outcomes between groups. RSS and RSA significantly improved from pre to posttreatment in the entire cohort and in all patient groups. VHI, dysphonia and roughness, maximum phonation time, Jitter, Shimmer and noise to harmonic ratio significantly improved from pre to posttreatment. Individuals with alkaline reflux reported better voice quality improvements as compared to acid and weakly acid reflux patients. CONCLUSION Patients with acid and alkaline reflux reported better posttreatment voice quality outcomes as compared to weakly acid reflux patients. Future basic science and clinical studies are needed to better understand the histological changes of the vocal folds due to reflux of varying pH types and gastroduodenal enzyme content.
Collapse
Affiliation(s)
- Jerome R Lechien
- Department of Otolaryngology, ELSAN Hospital, Paris, France; Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France; Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
| | - Thomas L Carroll
- Department of Otolaryngology, Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Géraldine Nowak
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Kathy Huet
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Harmegnies
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Lechien
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Mihaela Horoi
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Dequanter
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge D Le Bon
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Sven Saussez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, University Paris Saclay, Paris, France; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; Division of Gastroenterology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
6
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
7
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
9
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.)
| |
Collapse
|
10
|
Kurahara Y, Kanaoka K, Tanaka Y, Maeda Y, Kobayashi T, Takeuchi N, Kagawa T, Tachibana K, Yoshida S, Tsuyuguchi K. Management of dysphonia caused by amikacin liposome inhalation in M. avium complex pulmonary disease. Int J Tuberc Lung Dis 2023; 27:872-873. [PMID: 37880889 DOI: 10.5588/ijtld.23.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Affiliation(s)
- Y Kurahara
- Department of Internal Medicine, Department of Infectious Diseases, and, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| | - K Kanaoka
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| | - Y Tanaka
- Department of Internal Medicine, Department of Infectious Diseases, and
| | - Y Maeda
- Department of Otorhinolaryngology, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Osaka, Japan
| | - T Kobayashi
- Department of Otorhinolaryngology, Japan Community Healthcare Organization, Osaka Hospital, Osaka, Osaka, Japan
| | | | | | - K Tachibana
- Department of Internal Medicine, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| | - S Yoshida
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| | - K Tsuyuguchi
- Department of Internal Medicine, Department of Infectious Diseases, and, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka
| |
Collapse
|
11
|
Lagos-Villaseca A, Bhatt NK, Abdolhosseini P, Quinonez L, Paoletti MF, Gochman G, Johns MM, Rosen CA, Kao TC, Meyer TK. Assessment of Patients Receiving Short-Interval Botulinum Toxin Chemodenervation Treatment for Laryngeal Dystonia and Essential Tremor of the Vocal Tract. JAMA Otolaryngol Head Neck Surg 2023; 149:615-620. [PMID: 37227721 PMCID: PMC10214177 DOI: 10.1001/jamaoto.2023.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/29/2023] [Indexed: 05/26/2023]
Abstract
Importance The gold-standard treatment for laryngeal dystonia (LD) and essential tremor of the vocal tract (ETVT) is botulinum toxin (BoNT) chemodenervation. Although safe and effective, it is not curative, and periodic injections are required. Some medical insurance companies only cover injections at a 3-month interval, though some patients benefit from injections more frequently. Objective To determine the proportion and characteristics of patients who receive BoNT chemodenervation treatment in intervals shorter than 90 days. Design, Setting, and Participants This retrospective cohort study across 3 quaternary care neurolaryngology specialty practices in Washington and California recruited patients who underwent at least 4 consecutive laryngeal BoNT injections for LD and/or ETVT in the past 5 years. Data were collected from March through June 2022 and analyzed from June through December 2022. Exposure Laryngeal BoNT treatment. Main Outcomes and Measures Biodemographic and clinical variables, injection characteristics, evolution during the 3 interinjection intervals, and lifetime laryngeal BoNT treatment data were collected from patient medical records. Logistic regression was used to assess association to the short-interval outcome, defined as an average injection interval shorter than 90 days. Results Of 255 patients included from the 3 institutions, 189 (74.1%) were female, and the mean (SD) age was 62.7 (14.3) years. The predominant diagnosis was adductor LD (n = 199 [78.0%]), followed by adductor dystonic voice tremor (n = 26 [10.2%]) and ETVT (n = 13 [5.1%]). Seventy patients (27.5%) received short-interval injections (<90 days). The short-interval group was younger than the long-interval group (≥90 days), with a mean (SD) age of 58.6 (15.5) years and 64.2 (13.5) years, respectively, and a mean difference of -5.7 years (95% CI, -9.6 to -1.8 years). There were no patient-related differences between the short- and long-interval groups in terms of sex, employment status, or diagnosis. Conclusions and Relevance This cohort study demonstrated that while insurance companies often mandate a 3-month or greater interval for BoNT chemodenervation financial coverage, there is a considerable subset of patients with LD and ETVT who receive short-interval treatment to optimize their vocal function. Short-interval chemodenervation injections demonstrate a similar adverse effect profile and do not appear to predispose to resistance through antibody formation.
Collapse
Affiliation(s)
- Antonia Lagos-Villaseca
- UCSF Voice and Swallowing Center, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Neel K. Bhatt
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
| | | | - Leonel Quinonez
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
| | - Marcus F. Paoletti
- USC Voice Center, Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Los Angeles
| | - Grant Gochman
- UCSF Voice and Swallowing Center, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
| | - Michael M. Johns
- USC Voice Center, Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Los Angeles
| | - Clark A. Rosen
- UCSF Voice and Swallowing Center, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
| | - Tzu-Cheg Kao
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
| | - Tanya K. Meyer
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
| |
Collapse
|
12
|
Yeung W, Richards AL, Novakovic D. Botulinum Neurotoxin Therapy in the Clinical Management of Laryngeal Dystonia. Toxins (Basel) 2022; 14:toxins14120844. [PMID: 36548741 PMCID: PMC9784062 DOI: 10.3390/toxins14120844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Laryngeal dystonia (LD), or spasmodic dysphonia (SD), is a chronic, task-specific, focal movement disorder affecting the larynx. It interferes primarily with the essential functions of phonation and speech. LD affects patients' ability to communicate effectively and significantly diminishes their quality of life. Botulinum neurotoxin was first used as a therapeutic agent in the treatment of LD four decades ago and remains the standard of care for the treatment of LD. This article provides an overview of the clinical application of botulinum neurotoxin in the management of LD, focusing on the classification for this disorder, its pathophysiology, clinical assessment and diagnosis, the role of laryngeal electromyography and a summary of therapeutic injection techniques, including a comprehensive description of various procedural approaches, recommendations for injection sites and dosage considerations.
Collapse
Affiliation(s)
- Winnie Yeung
- Voice Research Laboratory, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Department of Otolaryngology, The Canterbury Hospital, Campsie, NSW 2194, Australia
- Correspondence:
| | - Amanda L. Richards
- Department of Otolaryngology, The Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Daniel Novakovic
- Voice Research Laboratory, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Department of Otolaryngology, The Canterbury Hospital, Campsie, NSW 2194, Australia
| |
Collapse
|
13
|
Osipenko EV, Karneeva OV, Kim IA, Orlova OS, Kotelnikova NM, Mikhalevskaya IA, Krivykh YS, Isaeva ML. [Results of a prospective observational study of the effectiveness of the complex drug Homeovox in adult patients with various types of dysphonia]. Vestn Otorinolaringol 2022; 87:71-78. [PMID: 36107184 DOI: 10.17116/otorino20228704171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
UNLABELLED The voice as the most important means of communication is of great importance in a person's life. Every year the number of specialties for which voice and speech are a key tool of professional activity increases. Diseases of the vocal apparatus reduce the ability to work, and for some people pose a threat of professional unfitness. The relevance of the study is determined not only by the significant prevalence of dysphonia, but also by the insufficient effectiveness of existing methods of treating voice disorders. OBJECTIVE To evaluate the clinical efficacy and safety of the use of the drug Homeovox in patients with acute and chronic catarrhal laryngitis as monotherapy. To fulfill the set goal of the study, the following tasks were solved: evaluation of the clinical effectiveness of the drug Homeovox as monotherapy for various types of dysphonia; evaluation of the effectiveness of the drug Homeovox as monotherapy from the 1st day of use. MATERIAL AND METHODS The basis for the implementation of the tasks was the analysis of the results of the examination and treatment of 60 patients with voice disorders aged 18 to 75 years. Among them, 10 (17%) patients with acute laryngitis and 50 (83%) patients with chronic laryngitis. To establish the diagnosis, a comprehensive examination was carried out, involving examination, videolaryngostroboscopy, acoustic analysis of the voice. The study design included three patient visits, during which the functional state of the vocal apparatus was examined by subjective and objective methods. RESULTS As a result of the treatment with the use of the drug Homeovox, the efficacy and safety of this drug in the treatment of dysphonia in adult patients with acute and chronic laryngitis from the first days of therapy has been proven, which is confirmed by the method of videolaryngostroboscopy and acoustic analysis of the voice. CONCLUSION The drug Homeovox is an effective, safe remedy and can be included in the complex treatment of laryngeal pathology in order to increase its effectiveness and achieve a therapeutic effect in a shorter time, manifested by an improvement in the clinical and functional state of larynx.
Collapse
Affiliation(s)
- E V Osipenko
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O V Karneeva
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I A Kim
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O S Orlova
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
- Moscow Pedagogical State University, Moscow, Russia
- FFederal Center for Brain and Neurotechnology, Moscow, Russia
| | - N M Kotelnikova
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - I A Mikhalevskaya
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - Yu S Krivykh
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| | - M L Isaeva
- National Medical Research Center for Otorhinolaryngology, Moscow, Russia
| |
Collapse
|
14
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.)
| |
Collapse
|
15
|
Yorkston K, Baylor CR, Eadie T, Kapsner-Smith M. Perceptions regarding communicative participation in individuals receiving botulinum toxin injections for laryngeal dystonia. Int J Lang Commun Disord 2021; 56:1296-1315. [PMID: 34453393 DOI: 10.1111/1460-6984.12668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Laryngeal dystonia (LD), or spasmodic dysphonia (SD), is a neurological disorder characterized by focal dystonia or involuntary spasms of the laryngeal muscles and associated voice symptoms. It is typically treated with injection of botulinum toxin (BoNT) that weakens the affected muscles. AIMS The primary purpose of this qualitative study was to explore participants' experience of living with LD and BoNT treatment. The secondary purpose was to examine those experiences as a function of participants' scores on the Communicative Participation Item Bank (CPIB). Results will enhance our understanding of restrictions in communicative participation, assist in planning intervention targeting these restrictions and aid in clinical interpretation of CPIB scores. METHODS & PROCEDURES Semi-structured interviews using a phenomenological tradition and focusing on BoNT treatment and communicative participation were conducted with 26 people with LD who are on established BoNT treatment regimens. Interviews were recorded, transcribed, coded and analysed inductively. Participants were categorized by CPIB scores into groups ranging from none to extensive participation restrictions. Both self- and expert ratings of voice were obtained. OUTCOMES & RESULTS Participants with different levels of CPIB scores had different experiences related to communicative participation in the context of BoNT treatment. These differences were organized into the following topics: BoNT and voice; attitudes toward participation; coping strategies; and advice. For all participants except those in the least restricted and most restricted groups, expert ratings of voice did not relate to CPIB scores. CONCLUSIONS & IMPLICATIONS Although most participants report improved voice with BoNT treatment, many participants experienced lingering restrictions in communicative participation, some to a severe extent. Participants reported coping with these restrictions in many ways; some of these strategies were more successful than others. Those with restricted participation recommended more support for daily life and the emotional toll of LD, as well as support for family members. This support might be offered by speech-language pathologists. WHAT THIS PAPER ADDS What is already known on the subject Participants with different levels of CPIB scores had different experiences related to communicative participation in the context of BoNT treatment. What this study adds to the existing knowledge Although most participants report improved voice with BoNT treatment, many participants experienced lingering restrictions in communicative participation, some to a severe extent. What are the potential or actual clinical implications of this work? SLP services that take a participation-focused approach to intervention and use multi-factorial approaches to help clients maximize their life participation in the context of LD are well within the SLP scope of practice. SLPs can help clients find and use their optimal voices within the constraints of the dystonia and BoNT effects.
Collapse
Affiliation(s)
- Kathryn Yorkston
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Carolyn R Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Tanya Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Mara Kapsner-Smith
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
16
|
Samaha M, Remacle M. Coagulation of posterior cricoarytenoid muscles for abduction spasmodic dysphonia. Eur Arch Otorhinolaryngol 2021; 278:839-841. [PMID: 33392763 DOI: 10.1007/s00405-020-06485-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Spasmodic dysphonia (SD), a form of focal dystonia, has been defined as a neurogenic, task-specific disorder characterized by abrupt spasms of intrinsic laryngeal muscles that result in phonatory breaks. There are three classic types of SD: adductor SD, abductor (ABSD) and mixed SD. Compared with the more common adductor form, treatment of ABSD with botulinum toxin injection is related to a shorter efficacy and improvement in only about 70% of patients [Blitzer et al. in Laryngoscope 108:1435-1441, 1998]. Moreover, due to the possible loss of efficacy over time or patient refusal for repeated injections, surgical solutions for permanent or at least long-term results must be considered. METHOD The surgical technique we propose is based on transoral bilateral posterior cricoarytenoid muscle (PCA) coagulation by radiofrequency (Celon, pro surg 250-T30, Olympus, Germany, 10 W, in 3 spots, each side) under a microscope or rigid scope control. The procedure is performed in two sessions distant of 2-3 weeks to avoid the risk of bilateral vocal fold temporary paralysis in adduction. A 52-year-old female patient with no audible voicing, resistant to botulinum toxin and after failure of relaxation thyroplasty type III according to lssihki [Saito et al. in Case Rep Otolaryngol 2018:4280381, 2018] showed an improvement of the Voice Handicap Index (VHI-10) from 35/40 to 19/40. The patient was rated G2R3B2A1S2 according to GRABS scale. CONCLUSION PCA coagulation for ABSD is a safe and reusable surgical option. It is less invasive than other techniques described before. To the best of our knowledge, this technique was never reported before in this type of SD.
Collapse
Affiliation(s)
- Marc Samaha
- Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg.
| | - Marc Remacle
- Centre Hospitalier du Luxembourg, Luxembourg, Luxembourg
| |
Collapse
|
17
|
Oktay Arslan B, Demirhan E, Uçar Hoşgör ZZ. Laryngeal Botulinum Toxin Injection: Can It Be a Cause of Obstructive Sleep Apnea as an Adverse Effect? J Voice 2020; 36:119-122. [PMID: 32482493 DOI: 10.1016/j.jvoice.2020.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/12/2022]
Abstract
Spasmodic dysphonia is a chronic voice disorder that is characterized by involuntary spasms of the laryngeal muscles during speech production. Botulinum toxin injection into to the laryngeal muscles is the most common and effective treatment of choice for symptoms of spasmodic dysphonia. We present a 44-year-old man with adductor spasmodic dysphonia who was diagnosed as having upper airway obstruction in a polysomnographic examination during sleep after a botulinum toxin injection.
Collapse
Affiliation(s)
- Burcu Oktay Arslan
- Department of Chest Medicine, Sleep Disorders Center, University of Health Science, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey.
| | - Erhan Demirhan
- Department of Otorhinolaryngology, University of Health Science, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Zeynep Zeren Uçar Hoşgör
- Department of Chest Medicine, Sleep Disorders Center, University of Health Science, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
18
|
Modak T, Singh S, Kumaran S, Deb KS, Chadda RK. Lorazepam-Assisted Interview in a Resistant Case of Functional Dysphonia. J Voice 2019; 34:811.e7-811.e11. [PMID: 30704785 DOI: 10.1016/j.jvoice.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/25/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Functional neurological symptom disorder presents with varied neurological signs often as a result of stress. It is usually treated with supportive psychotherapy and occasionally antidepressants. Literature regarding treatment for resistant cases is scarce. We describe on such presentation. CASE PRESENTATION A 40-year-old man who presented with a history of sudden onset dysphonia for 5 days. There were no immediate stressors. Physical examination revealed that he was unable to make movements of the tongue while speaking although power and range of movement were normal. Magnetic resonance imaging and computed tomography of brain and endoscopic examination of oral cavity and larynx did not reveal any organic cause. Functional magnetic resonance imaging imaging was conducted under a language protocol to determine neurophysiological circuits involved in this unique presentation. The patient failed conventional pharmacotherapy and supportive psychotherapy. Thereafter, he underwent lorazepam-assisted interviews where he would be asked to made purposive movements of the tongue and attempt to pronounce basic phonemes. He would converse normally during the lorazepam interviews and made gradual improvements after each session. The patient was able speak clearly after 12 such sessions and continues to maintain well since. CONCLUSIONS We describe a resistant case of functional dysphonia. The patient presented without any stressor and failed conventional treatments. The case demonstrates that Lorazepam can be used effectively in drug-assisted interviews for functional dysphonia. It also provides information regarding functional activity of the brain during a dissociative state.
Collapse
Affiliation(s)
- Tamonud Modak
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Saurabh Singh
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Senthil Kumaran
- Department of NMR, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Koushik Sinha Deb
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rakesh K Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| |
Collapse
|
19
|
Eadie TL, Rajabzadeh R, Isetti DD, Nevdahl MT, Baylor CR. The Effect of Information and Severity on Perception of Speakers With Adductor Spasmodic Dysphonia. Am J Speech Lang Pathol 2017; 26:327-341. [PMID: 28249075 DOI: 10.1044/2016_ajslp-15-0191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 09/22/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to examine the effect of severity of adductor spasmodic dysphonia (ADSD) and information about it on unfamiliar listeners' attitudes about speakers' personal characteristics, perceived vocal effort, and listener comfort on the basis of ratings of speech recordings. METHOD Fifteen women with ADSD and 5 controls provided speech samples. Forty-five unfamiliar listeners were randomized into 3 groups. Listeners in Group 1 received no information, listeners in Group 2 were told that some speakers had voice disorders or had no voice concerns, and listeners in Group 3 were provided diagnostic labels for each speaker and information about ADSD. Listeners then rated speech samples for attitudes, perceived vocal effort, and listener comfort. RESULTS Speakers with ADSD were judged significantly worse than controls for attitudes related to "social desirability" and "intellect." There was no effect of severity on "personality" attributes. However, provision of a diagnostic label resulted in significantly more favorable personality ratings than when no label was provided. Perceived vocal effort and comfort became significantly more negative as ADSD severity increased. Finally, most listener ratings were unaffected by provision of additional information about ADSD. CONCLUSIONS Listeners' perceptions about speakers with ADSD are difficult to change. Directions for counseling and public education need future study.
Collapse
Affiliation(s)
- Tanya L Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Reyhaneh Rajabzadeh
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Derek D Isetti
- Department of Speech-Language Pathology and Audiology, University of the Pacific, Stockton, CA
| | - Martin T Nevdahl
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Carolyn R Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| |
Collapse
|
20
|
Isetti DD, Baylor CR, Burns MI, Eadie TL. Employer Reactions to Adductor Spasmodic Dysphonia: Exploring the Influence of Symptom Severity and Disclosure of Diagnosis During a Simulated Telephone Interview. Am J Speech Lang Pathol 2017; 26:469-482. [PMID: 28492935 DOI: 10.1044/2016_ajslp-16-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 12/05/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to determine the influence of symptom severity and disclosure of adductor spasmodic dysphonia (ADSD) on the perceptions of human resource personnel members (HRPs) during a simulated phone interview. METHOD One female speaker with ADSD was recorded reading an interview script at two time points: (a) pre-BOTOX injection (severe), and (b) post-BOTOX injection (mild). Thirty-two HRPs evaluated the recording in one of the two conditions via a qualitative structured interview. HRPs gave their recommendations regarding when and how to disclose ADSD. RESULTS In the mild condition, no HRP perceived that the applicant had a voice disorder. Disclosure was not recommended as often, as an impairment was not initially noticed. However, 15/16 HRPs commented on the applicant's voice in the severe condition, with most suspecting she was a smoker or had lung/throat cancer. Disclosure in the severe condition was recommended more often, as it clarified symptoms that were noted at the outset. CONCLUSIONS Symptom severity in ADSD influences employer perceptions during the phone interview process. Incorrect assumptions may be made about applicants with severe symptoms, and apparentness of symptoms influences whether or not disclosure is recommended. Results have implications for counseling individuals with ADSD who are navigating the job interview process.
Collapse
Affiliation(s)
- Derek D Isetti
- Department of Speech Language Pathology and Audiology, University of the Pacific, Stockton, CA
| | - Carolyn R Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Michael I Burns
- Speech and Hearing Sciences, University of Washington, Seattle
| | - Tanya L Eadie
- Speech and Hearing Sciences, University of Washington, Seattle
| |
Collapse
|
21
|
Kosztyła-Hojna B, Berger G, Zdrojkowski M. [Analysis of phonosurgical methods of treatment in spasmodic dysphonia]. Pol Merkur Lekarski 2017; 42:90-92. [PMID: 28258685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Spasmodic dysphonia (SD) is rather a rare voice disorder. It is most often seen in woman aged 40-50. The disease is caused by deep emotional and neurological disorders of extrapyramidal system. Two main clinical forms of SD are distinguished: about 90% of cases - adductor spasmodic dysphonia and abductor spasmodic dysphonia roughly 10%. Conservative therapy does not always yield sufficient effects. Botulinum toxin - type A injections into the thyroarytenoid muscle are also used in therapy. Though results are temporary and reversible. Among phonosurgical methods thyroplasty type II according to Isshiki and tyroarytenoid muscle myectomy (TAM) should be also mentioned among phonosurgical methods. The aim of the work is to evaluate results of conservative and phonosurgical treatment of SD. Spasmodic dysphonia markedly restricts communication process of patients and public relations both social and occupational.
Collapse
Affiliation(s)
- Bożena Kosztyła-Hojna
- Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok, Poland
| | - Greta Berger
- Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok, Poland
| | - Maciej Zdrojkowski
- Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok, Poland
| |
Collapse
|
22
|
Benyamini L, Awwad F, Gil Z, Cohen JT. [IN-OFFICE VOCAL CORD INJECTION FOR TREATMENT OF DYSPHONIA]. Harefuah 2016; 155:656-659. [PMID: 28530069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Dysphonia significantly damages quality of life and employment opportunities. One of the common causes of hoarseness is glottic insufficiency, namely the lack of full adherence of the vocal cords during speech and swallowing. Correction is achieved by vocal cord medialization. OBJECTIVES To examine the effect of vocal cord injection with carboxymethyl cellulose and hydroxyapatite under local anesthesia in the office, on the voice objectively, assessment by staff and patient satisfaction. METHODS This prospective and retrospective study included 38 vocal cord injections: 30 involved carboxymethyl cellulose injections, and 8 were injected with hydroxyapatite. Objective and subjective parameters were collected before the injection and 1-2 weeks after the injection. RESULTS Average subjective disturbance of the voice decreased from 5.9 to 4.1 post-injection (p<0.01). Average Voice Handicap Index (VHI) decreased from 75.3 to 39.1 (p<0.01) and average Glottic Function Index (GFI) decreased from 15.7 to 9.5 (p<0.01). Average GRABS decreased from 11.9 to 6 (p<0.01) and average visual analogue scale decreased from 4 to 2.5 (p<0.01). Average Maximal Phonation Time increased from 6.9 to 9 sec (p=0.1). Average S/Z ratio decreased from 1.8 to 1.3 (p=0.1). Voice analysis showed average jitter decreased from 2.4% to 0.8% (p<0.01) and average shimmer from 10.9% to 5% (p<0.01). CONCLUSIONS Vocal cord injection under local anesthesia in the office is a good and safe method for treating glottic insufficiency. Vocal cord injection with carboxymethyl cellulose and hydroxyapatite improves objective and subjective voice properties.
Collapse
Affiliation(s)
- Limor Benyamini
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Faten Awwad
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Jacob T Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Medical Center, Rappaport Medical School, The Technion, Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
23
|
Blitzer A, Brin MF, Stewart CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 2015. [PMID: 26200329 DOI: 10.1002/lary.25273] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
24
|
de Souza AMV, de Campos Duprat A, Costa RC, de Oliveira Pimenta J, de Sá Andrade FF, da Silva FF. Use of inhaled versus oral steroids for acute dysphonia. Braz J Otorhinolaryngol 2013; 79:196-202. [PMID: 23670326 PMCID: PMC9443858 DOI: 10.5935/1808-8694.20130035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/29/2012] [Indexed: 11/30/2022] Open
Abstract
Acute dysphonia is a frequent condition in clinical practice. Its treatment, especially in adults, is not well established in the literature. Steroids are the most recommended drug treatment. However, the existing studies are not enough to establish superiority among the different steroids and the best route of administration. Objective This prospective clinical study aimed at comparing the effect of inhaling steroids as a dry powder with the effect of oral steroids to treat acute dysphonia. Method We assessed 32 adult patients, broken down into two groups of 16 patients in each one of the treatments, before and seven days after the use of the medication. The patients were submitted to videolaryngoscopy and perceptive and acoustic voice assessment. Result Oral and inhalation treatment significantly reduced hyperemia and edema, and improved the muco-ondulatory movement; nonetheless, edema reduction was statistically more significant (p = 0.012) in the patients treated with the inhalation form of the drug. However, comparing the values of the auditory perceptive analysis and the acoustic measures after treatment between the groups was not statistically significant. Conclusion There was a significant improvement in the acute laryngitis concerning the assessments carried out in all the patients assessed, concerning the two treatments. The inhalation steroid treatment was significantly more effective in reducing the edema.
Collapse
Affiliation(s)
- Andréa Moreira Veiga de Souza
- MD MSc - Otorhinolaryngologist - Espaço da voz - MG - Brazil
- Send correspondence to: André de Campos Duprat. Av. 9 de Julho, nº 5519, cj 71. Jardim Europa. São Paulo - SP. Brazil. CEP: 01407-200. Fax: (11) 3168-6644
| | - André de Campos Duprat
- MD PhD - Otorhinolaryngologist. Professor at the Medical School of the Santa Casa - São Paulo
| | - Rejane Cardoso Costa
- MD Otorhinolaryngologist - Insttuto de Otorrinolaringologia de Minas Gerais - Brazil
| | - Janaína de Oliveira Pimenta
- MSc - Speech and Hearing Therapist - Espaço da voz - MG - Brazil. Irmandade da Santa Casa de Misericórdia de São Paulo
| | | | - Fernanda Ferreira da Silva
- MSc - Speech and Hearing Therapist - Espaço da voz - MG - Brazil. Irmandade da Santa Casa de Misericórdia de São Paulo
| |
Collapse
|
25
|
Dejonckere PH, Neumann KJ, Moerman MBJ, Martens JP, Giordano A, Manfredi C. Tridimensional assessment of adductor spasmodic dysphonia pre- and post-treatment with Botulinum toxin. Eur Arch Otorhinolaryngol 2011; 269:1195-203. [PMID: 22210475 PMCID: PMC3311985 DOI: 10.1007/s00405-011-1890-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/12/2011] [Indexed: 11/27/2022]
Abstract
Spasmodic dysphonia voices form, in the same way as substitution voices, a particular category of dysphonia that seems not suited for a standardized basic multidimensional assessment protocol, like the one proposed by the European Laryngological Society. Thirty-three exhaustive analyses were performed on voices of 19 patients diagnosed with adductor spasmodic dysphonia (SD), before and after treatment with Botulinum toxin. The speech material consisted of 40 short sentences phonetically selected for constant voicing. Seven perceptual parameters (traditional and dedicated) were blindly rated by a panel of experienced clinicians. Nine acoustic measures (mainly based on voicing evidence and periodicity) were achieved by a special analysis program suited for strongly irregular signals and validated with synthesized deviant voices. Patients also filled in a VHI-questionnaire. Significant improvement is shown by all three approaches. The traditional GRB perceptual parameters appear to be adequate for these patients. Conversely, the special acoustic analysis program is successful in objectivating the improved regularity of vocal fold vibration: the basic jitter remains the most valuable parameter, when reliably quantified. The VHI is well suited for the voice-related quality of life. Nevertheless, when considering pre-therapy and post-therapy changes, the current study illustrates a complete lack of correlation between the perceptual, acoustic, and self-assessment dimensions. Assessment of SD-voices needs to be tridimensional.
Collapse
Affiliation(s)
- P H Dejonckere
- University Medical Centre, ORL Phoniatrics, Utrecht University, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
26
|
Groen JL, Yildirim E, Ritz K, Baas F, van Hilten JJ, van der Meulen FW, Langeveld TP, Tijssen MAJ. THAP1 mutations are infrequent in spasmodic dysphonia. Mov Disord 2011; 26:1952-4. [PMID: 21538522 DOI: 10.1002/mds.23682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
27
|
Lindberg L, Kanerva M, Pitkäranta A, Ansaranta M, Ylitalo L, Aaltonen LM, Pakarinen M, Salmenkylä S. [Applications of botulin]. Duodecim 2011; 127:2431-2443. [PMID: 22238921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Among the ailments of the ocular region, the use of botulin has become established in the treatment of blepharospasm and hemifacial spasm in Finland. Botulin has also been used successfully after peripheral facial palsy to improve facial symmetry, reduce lachrymal flow, treat dribbling of saliva as well as spasmodic dysphonia of laryngeal muscles. It may be effective in dysphagia caused by tightness of the upper esophageal sphincter or in several dyshidroses. Gastroenterologic indications include anal fissure and spasm and achalasia of the lower esophageal sphincter. In urology, botulin is effective in overactive bladder and incomplete voiding.
Collapse
|
28
|
|
29
|
Eskander A, Fung K, McBride S, Hogikyan N. Current practices in the management of adductor spasmodic dysphonia. J Otolaryngol Head Neck Surg 2010; 39:622-630. [PMID: 20828529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Adductor spasmodic dysphonia (ADSD) is a focal dystonia treated most commonly by chemodenervation of the thyroarytenoid (TA) muscles with botulinum toxin. Currently, there are no consensus guidelines regarding this treatment and the management of ADSD. The objective of this study was to assess current practice patterns among physicians who treat ADSD. METHODS A cross-sectional survey study was conducted regarding treatment choices and specific technical aspects of injection technique and botulinum toxin use. The study population consisted of laryngologists from the Canadian Society of Otolaryngology-Head and Neck Surgery and laryngologists obtained from the American Laryngological Association member database and the American Academy of Otolaryngology-Head and Neck Surgery Neurolaryngology Study Group. RESULTS An overall response rate of 13% was achieved, with a high absolute number of physicians who manage ADSD responding (n = 37). Most respondents treat ADSD by injecting botulinum toxin type A (Botox) through the cricothyroid membrane submucosally at a mode starting dose of 2.5 units per TA muscle using electromyographic guidance with or without fibre-optic laryngoscopy every 3 to 4 months, with the frequency of reinjection being based on patient symptomatology. There is much variability with regard to starting injection dose, alternate treatments for ADSD, unilateral versus bilateral injections, and guidance technique. Most physicians (36 of 37) share one vial among more than one patient, and some (7 of 37) freeze a reconstituted vial that has remaining toxin for reuse at a later time. CONCLUSIONS There is considerable variability in treatment practices for the management of ADSD. Further study is warranted to define an optimal therapeutic paradigm.
Collapse
|
30
|
Affiliation(s)
- A Blitzer
- Columbia University College of Physicians, New York, NY 10019, USA.
| |
Collapse
|
31
|
Singh V, Cohen SM, Rousseau B, Noordzij JP, Garrett CG, Ossoff RH. Acute dysphonia secondary to vocal fold hemorrhage after vardenafil use. Ear Nose Throat J 2010; 89:E21-E22. [PMID: 20556726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Owing to their vasodilatory effects, the phosphodiesterase-5 inhibitors have become widely used for the treatment of erectile dysfunction. Among the reported adverse events of these agents are epistaxis, variceal bleeding, intracranial hemorrhage, and hemorrhoidal bleeding. We report a case of vocal fold hemorrhage that occurred after vardenafil use in a 31-year-old man who was a professional singer.
Collapse
Affiliation(s)
- Vikas Singh
- Department of Otolaryngology, Vanderbilt University School of Medicine, 7302 Medical Center East, South Tower, 1215 21st Ave. South, Nashville, TN 37232-8783, USA
| | | | | | | | | | | |
Collapse
|
32
|
Gama ACC, Menezes LN, Maia AA, Rezende Neto AL, Oliveira JB. Voice related quality of life after botulinum toxin injection for spasmodic dysphonia. Rev Laryngol Otol Rhinol (Bord) 2010; 131:39-44. [PMID: 21077414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Laryngeal Focal Dystonia (LFD) leads to a type of voice with a strained and tense quality which has a neurological origin, affecting the social-emotional realms of the individuals, and their quality of life. AIMS Measure the voice-related quality of life of patients with Adductor LFD pre and post-treatment with Botox, injection followed by voice therapy, using the Voice-Related Quality of Life (V-RQOL). STUDY DESIGN Prospective study. METHODS Adductor 11 female patients aged between 33 and 74 years with a diagnosis of Adductor LFD were evaluated. All patients underwent a neurological evaluation. Laryngoscopy was performed with both rigid and flexible endoscopes. Speech and Language evaluation followed the Evaluation of Voice Protocol, proposed by Behlau, Pontes (1995). The American V-RQOL measure was utilized. RESULTS Statistical analysis demonstrated significant difference (p < 0.05). 81.8% of patients showed higher scores post-Botox, for the social-emotional and physical domain. In the overall V-RQOL scores 72.7% of patients showed greater scores post-treatment. CONCLUSIONS There was an improvement in the quality of life for these patients post-treatment. The V-RQOL proved to be an efficient tool to measure the treatment outcomes of LFD pre and post botulinum toxin injection.
Collapse
Affiliation(s)
- A C C Gama
- Department of the Federal University of Minas Gerais, Rua Luiz Fernando 47, Santa Mônica, 31530-630 Belo Horizonte, Minas Gerais, Brazil.
| | | | | | | | | |
Collapse
|
33
|
Chang CY, Chabot P, Walz CM. A survey of current practices of physicians who treat adductor spasmodic dysphonia in the U.S. Ear Nose Throat J 2009; 88:E18. [PMID: 19444777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
We conducted a survey to determine the current practices of a subset of physicians in the United States who treat patients with adductor spasmodic dysphonia. Surveys were sent to 169 physicians listed in the National Spasmodic Dysphonia Association database, and responses were returned by 43 (25.4%). Almost all respondents (95.4%) indicated that they use botulinum toxin type A injections, either alone or in combination with other treatments, to treat adductor spasmodic dysphonia, and most (69.8%) inject the toxin under electromyographic guidance. However, there were wide variations in the amount of sterile saline used to reconstitute the toxin, the size of the initial dose, and the use of other treatment strategies.
Collapse
|
34
|
Naseri I, Wise SK, Klein AM. A rare cause of dysphonia. Ear Nose Throat J 2008; 87:E09. [PMID: 18712682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Although dysphonia is a common complaint among patients seen in an otolaryngology clinic, an autoimmune cause of the problem is less common. Autoimmune disease can be the source of various laryngologic manifestations, but diagnosis depends on a high index of suspicion, careful patient evaluation and testing, and videolaryngoscopy (videostroboscopy if available) to uncover specific identifying findings. This report describes a patient presenting with upper-range vocal difficulties who was found to have early systemic lupus erythematosus.
Collapse
Affiliation(s)
- Iman Naseri
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | | | | |
Collapse
|
35
|
Xu W, Han DM, Hou LZ, Zhang L, Gao YH, Ye JY, Wang J. [Patterns of spasmodic dysphonia and botulinum toxin injections]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2005; 40:253-7. [PMID: 16008256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To investigate the patterns of spasmodic dysphonia and the outcome treated with botulinum toxin A injections. METHODS All subjects were studied with acoustic analysis, laryngostroboscopy and laryngeal electromyography (EMG) including motor unit potential measure (MUP), recruitment pattern analysis and evoked electromyography. All the patients with spasmodic dysphonia were received botulinum toxin A (BOTOX) injections in each affected muscles and mostly under electromyographic guidance. RESULTS Among 22 cases of spasmodic dysphonia, 18 cases of adductor dysphonic patients have strained, strangled voice with intermittent breaks in speech as a consequence of hyperadduction and spasm of the vocal folds during phonation. Two patients had synchronous pharyngeal, lingual and velar tremor. Amplitudes of MUP of thyroarytenoid muscle (TA) were greater in patients group than in normal group (P < 0.01); The recruitment activity was increased and the amplitudes were greater than normal group (700-2500 microV) and the duration of activity of the TA during phonation was also notably greater in patients group than in normal group. Four cases of abductor dysphonic patients have a breathy, effortful hypophonic voice with abrupt termination of voicing. Amplitudes of MUP of posterior cricoarytenoid muscle (PCA) in patients group were increased up to 374 to 538 microV. The recruitment activity was increased and the amplitude was greater than normal(3000-5000 microV). In the adductor dysphonic group, patients who were treated with unilateral toxin injection had good results with 2.5 U or more. The average onset of toxin effect in all adductor dysphonic patients was at 6 hours to 2 days (1.4+/-0. 8) days (x +/- s), with a peak effect at 2 weeks and the follow-up EMG showed fibrillation potentials or electric silence in injected muscle. Duration of benefit was 8 to 24 weeks (15.2 +/- 4.9) weeks. The side-effect of toxin injection were including breathy voice or occasional dysphagia and aspiration. The patients with abductor spasms were less well controlled after PCA injections. CONCLUSIONS Spasmodic dysphonia was regarded as a neuromuscular diseases, so its diagnosis, classification, treatment and follow-up should depend on not only clinical manifestation but also EMG. Presently, for controlling the dystonic symptoms, the most effective therapy for most of those patients is local BOTOX injections. Repeated injections are required to have a stable results.
Collapse
Affiliation(s)
- Wen Xu
- Department of Otorhinolaryngology Head Neck Surgery, Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing 100730, China.
| | | | | | | | | | | | | |
Collapse
|