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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Article info
Publication history
Published online: August 30, 2022
Accepted:
July 25,
2022
Publication stage
In Press Corrected ProofFootnotes
Presented at: The Voice Foundation Annual Meeting June 1-5, 2022 Philadelphia, Pa.
Conflict of interest: none.
Level of Evidence: IV Case series.
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
