Optimizing Botox regimens in patients with adductor spasmodic dysphonia and essential tremor of voice: A 31‐year experience

• DOI: 10.1002/lio2.915
• Publication Date: 2022-09-19T10:45:38Z
• Authors: Amy Stone; Maria E. Powell; Kaitlyn Hamers; K. Charles Fletcher; David O. Francis; Mark S. Courey; James L. Netterville; C. Gaelyn Garrett
• Keywords: RD1-811; voice disorders; essential tremor of the voice; Laryngology, Speech and Language Science; 3. Good health; 03 medical and health sciences; Botox treatment; 0302 clinical medicine; Otorhinolaryngology; RF1-547; Surgery; adductor spasmodic dysphonia

AbstractObjectiveThe purpose of this study was to quantitatively compare the effectiveness of unilateral and bilateral botulinum toxin A (BTX‐A) injections for mitigating undesirable weak/breathy voice quality and dysphagia for patients with adductor spasmodic dysphonia and/or essential tremor of voice (ETV).MethodsData were collected from the medical records of 319 patients, yielding three treatment cohorts: patients who received an equal dose bilateral injection regimen (BL=) throughout their course of treatment at VUMC, patients who switched to a unilateral injection regimen (UL), and patients who switched to an unequal dose bilateral injection regimen (BL≠). Changes in length of improvement, duration of weak/breathy voice, and dysphagia severity were compared.ResultsThe BL = treatment group reported the longest duration of improved voice. Shorter periods of improved voice were reported at baseline by patients who later switched to UL or BL ≠ injection regimens. Patients receiving UL injections reported significantly reduced weak/breathy voice and dysphagia. Patients receiving BL ≠ injections reported increased length of improved voice; however, dysphagia symptoms increased. Ninety‐two percent of patients with ETV switched to a UL regimen, with 61% of patients transitioning within the first three injections.ConclusionsPatients with pronounced dysphagia and extended periods of weak/breathy voice may benefit from a UL injection approach to mitigate side effects from BTX‐A without sacrificing improved voice outcomes. For patients seeking to extend their length of improved voice, a BL ≠ injection regimen may be effective provided the adverse side effects from BTX‐A are minimal. Patients with ETV may benefit from a UL injection approach at the outset of their course of treatment with BTX‐A.Level of evidenceIII.