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Simultaneous Botox and Augmentation Injection Laryngoplasty in Patients With Adductor Spasmodic Dysphonia (ASD) and Tremor

  • Peak Woo
    Correspondence
    Address correspondence and reprint requests to Peak Woo, 300 Central Park West 1-H, New York, New York, 10024.
    Affiliations
    Clinical Professor, Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mt. Sinai, New York, New York
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      Summary

      Objective

      Although Botulinum Toxin (BOTOX) is effective for adductor spasmodic dysphonia (ASD) and essential vocal tremor (EVT), the side effects of breathy dysphonia may result in reluctance to pursue BOTOX treatment. We sought to improve results in selected elderly tremor patients with EVT and in professional voice users with ASD by simultaneous BOTOX injection and injection laryngoplasty using Hyaluronic acid (HA/Botox).

      Material and Methods

      Between July 2018 and March 2022, 23 simultaneous HA/Botox using LEMG control were done in eight patients with ASD and EVT (23 of 406 Botox Injections). All eight patients have previously reported unwanted side effects with poor voice results with Botox. Three patients had tremor with presbyphonia. Injection of Botox is performed first using LEMG control, followed by bilateral LEMG guided injection of 0.1 cc of HA.

      Results

      All HA/Botox injections were tolerated well. All patients reported some improved voice. Two patients did not go on to further HA injections while the others six have requested ongoing simultaneous HA/Botox injections. Patients with EVT and presbyphonia noted greater stability of voice than Botox alone. It lasted through the injection cycle. The professional voice users reported less breathy voice that allowed them to work right after the BOTOX injection.

      Conclusion

      Simultaneous BOTOX injection with injection laryngoplasty using HA may be helpful in patients with tremor and presbyphonia. It also may be considered in professional voice users with ASD to reduce side effects of BOTOX.

      Key Words

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      REFERENCES

        • 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
        • Gurey LE
        • Sinclair CF
        • Blitzer A.
        A new paradigm for the management of essential vocal tremor with botulinum toxin.
        Laryngoscope. 2013; 123: 2497-2501
        • Warrick P
        • Dromey C
        • Irish JC
        • et al.
        Botulinum toxin for essential tremor of the voice with multiple anatomical sites of tremor: a crossover design study of unilateral versus bilateral injection.
        Laryngoscope. 2000; 110: 1366-1374
        • Kendall KA
        • Leonard RJ.
        Interarytenoid muscle botox injection for treatment of adductor spasmodic dysphonia with vocal tremor.
        J. Voice. 2011; 25: 114-119
        • Koriwchak MJ
        • Netterville JL
        • Snowden T
        • et al.
        Alternating unilateral botulinum toxin type A (BOTOX) injections for spasmodic dysphonia.
        Laryngoscope. 1996; 106: 1476-1481
        • Holzer SE
        • Ludlow CL.
        The swallowing side effects of botulinum toxin type A injection in spasmodic dysphonia.
        Laryngoscope. 1996; 106: 86-92
        • Galardi G
        • Guerriero R
        • Amadio S
        • et al.
        Sporadic failure of botulinum toxin treatment in usually responsive patients with adductor spasmodic dysphonia.
        Neurol Sci. 2001; 22: 303-306
        • Childs L
        • Rickert S
        • Murry T
        • et al.
        Patient perceptions of factors leading to spasmodic dysphonia: a combined clinical experience of 350 patients.
        Laryngoscope. 2011; 121: 2195-2198
        • Barkmeier-Kraemer J
        • Lato A
        • Wiley K.
        Development of a speech treatment program for a client with essential vocal tremor.
        Semin. Speech Lang. 2011; 32: 43-57
        • Zwirner P
        • Murry T
        • Swenson M
        • et al.
        Effects of botulinum toxin therapy in patients with adductor spasmodic dysphonia: acoustic, aerodynamic, and videoendoscopic findings.
        Laryngoscope. 1992; 102: 400-406
        • Novakovic D
        • Waters HH
        • D'Elia JB
        • et al.
        Botulinum toxin treatment of adductor spasmodic dysphonia: longitudinal functional outcomes.
        Laryngoscope. 2011; 121: 606-612
        • Meleca RJ
        • Hogikyan ND
        • Bastian RW
        A comparison of methods of botulinum toxin injection for abductory spasmodic dysphonia.
        Otolaryngol. Head Neck Surg. 1997; 117: 487-492
        • Schonweiler R
        • Wohlfarth K
        • Dengler R
        • et al.
        Supraglottal injection of botulinum toxin type A in adductor type spasmodic dysphonia with both intrinsic and extrinsic hyperfunction.
        Laryngoscope. 1998; 108: 55-63
        • Castellanos PF
        • Gates GA
        • Esselman G
        • et al.
        Anatomic considerations in botulinum toxin type A therapy for spasmodic dysphonia.
        Laryngoscope. 1994; 104: 656-662