Research Article| Volume 37, ISSUE 3, P452-455, May 2023

Download started.


Hemodynamic Changes Associated With Transcervical Laryngeal Injection of Botulinum Toxin

Published:February 01, 2021DOI:



      Laryngeal dystonia is a chronic neurologic disorder characterized by intention-induced spasms of the vocal folds driven by aberrant central motor processing. The use of in-office transcervical botulinum toxin injection for the treatment of laryngeal disorders, such as laryngeal dystonia, has been deemed safe and efficacious. There is, however, no available data outlining the hemodynamic changes experienced by patients undergoing this frequently performed procedure.


      One hundred and one patients diagnosed with laryngeal dystonia were enrolled in this prospective study. These patients underwent transcervical laryngeal botulinum toxin injection to address their dysphonia. Vital signs where acquired prior to, and at the time of injection. Alterations in these parameters were then evaluated for statistical significance.


      Statistically significant increases in mean heart rate (5.8 ± 10.8 bpm, P < 0.0001), systolic blood pressure and diastolic blood pressure (7.0 ± 9.5 mm Hg, P < 0.0001; 8.7 ± 14.7 mm Hg, P < 0.0001) were discovered. No statistically significant difference in oxygen saturation was noted and no patients in the study faced major adverse outcomes.


      Though these findings may not have related to clinically significant complication, our study demonstrates the importance of understanding potential stressors in a procedure routinely performed by laryngologists. This may result in more careful patient selection, alterations in procedure, and improved safety by acting in a timely fashion if alarming changes in hemodynamic parameters are noted.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Blitzer A
        • Brin MF
        • Stewart CF
        Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients.
        Laryngoscope. 1998; 108: 1435-1441
        • Yung KC
        • Courey MS
        The effect of office-based flexible endoscopic surgery on hemodynamic stability.
        Laryngoscope. 2010; 120: 2231-2236
        • Morrison MP
        • O'Rourke A
        • Dion GR
        • et al.
        Hemodynamic changes during otolaryngological office-based flexible endoscopic procedures.
        Ann Otol Rhinol Laryngol. 2012; 121: 714-718
        • Postma GN
        • Cohen JT
        • Belafsky PC
        • et al.
        Transnasal esophagoscopy: revisited (over 700 consecutive cases).
        Laryngoscope. 2005; 115: 321-323
        • Koufman JA
        • Rees CJ
        • Frazier WD
        • et al.
        Office-based laryngeal laser surgery: a review of 443 cases using three wave-lengths.
        Otolaryngol Head Neck Surg. 2007; 137: 146-151
        • Madden LL
        • Ward J
        • Ward A
        • et al.
        A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures.
        Laryngoscope. 2017; 127: 1845-1849
        • Zalvan CH
        • Blitzer A.
        Using botulinum toxin therapy in the laryngopharynx.
        Oper Tech Otolaryngol-Head Neck Surg. 2004; 15: 86-89
        • Shah MD
        • Johns MM
        Office-based botulinum toxin injections.
        Otolaryngol Clin North Am. 2013; 46: 53-61
        • Morzaria S
        • Damrose EJ.
        A comparison of the VHI, VHI-10, and V-RQOL for measuring the effect of botox therapy in adductor spasmodic dysphonia.
        J Voice. 2012; 26: 378-380
        • Blitzer A
        • Crumley RL
        • Dailey SHf
        • et al.
        Recommendations of the neurolaryngology study group on laryngeal electromyography.
        Otolaryngol-Head Neck Surg. 2009; 140: 782-793
        • Stachler RJ
        • Francis DO
        • Schwartz SR
        • et al.
        Clinical practice guideline: hoarseness (Dysphonia) (Update).
        Otolaryngol Neck Surg. 2018; 158: S1-S42
        • Rees CJ
        • Mouadeb DA
        • Belafsky PC.
        Thyrohyoid vocal fold augmentation with calcium hydroxyapatite.
        Otolaryngol-Head Neck Surg. 2008; 138: 743-746
        • Simpson CB
        • Lee CT
        • Hatcher JL
        • et al.
        Botulinum toxin treatment of false vocal folds in adductor spasmodic dysphonia: functional outcomes.
        Laryngoscope. 2016; 126: 118-121
        • Watts C
        • Nye C
        • Whurr R.
        Botulinum toxin for treating spasmodic dysphonia (laryngeal dystonia): a systematic cochrane review.
        Clin Rehabil. 2006; 20: 112-122
        • Blitzer A
        • Brin MF
        • Fahn S
        • et al.
        Localized injections of botulinum toxin for the treatment of focal laryngeal dystonia (spastic dysphonia).
        Laryngoscope. 1988; 98: 193-197
        • Pingree CS
        • Majors JS
        • Howard NS
        • et al.
        Laryngocardiac reflex: a case report and review of the literature.
        J Voice. 2018; 32: 633-635
        • Reeves RA.
        Does this patient have hypertension? How to measure blood pressure.
        JAMA. 1995; 273: 1211-1218
        • Abolbashari M.
        White coat hypertension and cardiovascular diseases: innocent or guilty.
        Curr Cardiol Rep. 2018; 20: 25
        • Naunheim M
        • Yung KC
        • Courey M.
        Timing of hemodynamic changes during transnasal endoscopic surgery.
        Laryngoscope. 2016; 126: 2047-2050
        • Zamanifar S
        • Bagheri-Saveh MI
        • Nezakati A
        • et al.
        The effect of music therapy and aromatherapy with chamomile-lavender essential oil on the anxiety of clinical nurses: a randomized and double-blind clinical trial.
        J Med Life. 2020; 13: 87-93