Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients: A Systematic Review

Esch, Babette F. van; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

doi:10.1177/0194599816675320

Cited by 22 publications

(11 citation statements)

References 48 publications

(376 reference statements)

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“…Boutsen et al 26 analyzed 30 studies and reported that BT therapy led to a moderate improvement; however, patient cohorts, measurements, and treatment conditions varied. A systematic review 27 found only one study with high methodological quality on BT therapy for ADSD. In that study, Troung et al, 28 which was a prospective, randomized, double‐blinded clinical trial with blinded outcome assessments, the BT group showed a significant reduction in voice perturbation and fundamental frequency range.…”

Section: Discussionmentioning

confidence: 99%

Post‐treatment clinical course following botulinum toxin injection therapy for adductor spasmodic dysphonia: Analysis of data from a placebo‐controlled, randomized, double‐blinded clinical trial in Japan

Hirose

Asano

Sakaguchi

et al. 2021

Laryngoscope Investig Oto

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Objective: Botulinum toxin (BT) therapy is a first-line treatment for spasmodic dysphonia (SD). However, a detailed chronological course and clinical factors that affect the therapeutic effect have been vague. In this study, we analyzed the data from our placebo-controlled, randomized, double-blinded parallel-group comparison/ open-label clinical trial of BT (Botox) to clarify these.Methods: A total of 22 patients with abductor SD (ADSD) were enrolled. The female-to-male ratio was 20:2 with a mean age of 40.0 ± 10.3 years and a median duration of symptoms of 7.5 years. The therapeutic effect was evaluated based on the change in the number of aberrant morae (phonemes), GRBAS scale, Voice Handicap Index (VHI), and Visual Analogue Scale (VAS). Results:The change in the number of aberrant morae peaked at 2 weeks and lasted for 12 weeks in the BT group with significance (P < .01) compared to the placebo group. Objective improvement (number of aberrant morae and [S] element in GRBAS) preceded subjective improvement (VHI and VAS). The change in number of aberrant morae and VHI showed a significant correlation (P < .01). The changes in the number of aberrant morae, VHI, and VAS in younger subjects were greater than in older subjects. Patients who presented with post-treatment breathy hoarseness or dysphagia showed better therapeutic effects.Conclusions: BT therapy was effective for ADSD based on both objective and subjective assessments. Improvements in subjective parameters were delayed compared to objective measures due to post-treatment breathy hoarseness. However, this adverse event was believed to reflect the treatment effect.

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Section: Discussionmentioning

confidence: 99%

Post‐treatment clinical course following botulinum toxin injection therapy for adductor spasmodic dysphonia: Analysis of data from a placebo‐controlled, randomized, double‐blinded clinical trial in Japan

Hirose

Asano

Sakaguchi

et al. 2021

Laryngoscope Investig Oto

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“…As stated in the systematic review by Van Esch et al, no clinical trial has been conducted to compare the effect of BTX injections with surgery among AdSD patients. 22 They concluded no preference for a particular surgical or longterm treatment could be advised. 22 Our study is the first to compare the effect of TA myoneurectomy with the current gold standard of therapy, BTX injection.…”

Section: Discussionmentioning

confidence: 99%

“…22 They concluded no preference for a particular surgical or longterm treatment could be advised. 22 Our study is the first to compare the effect of TA myoneurectomy with the current gold standard of therapy, BTX injection. Our results showed no statistically significant differences between the patientreported voice outcomes measured 3 or 12 months after TA myoneurectomy and the best voice outcomes after BTX treatment.…”

Section: Discussionmentioning

confidence: 99%

Adductor spasmodic dysphonia: Botulinum toxin a injections or laser thyroarytenoid myoneurectomy? A comparison from the patient perspective

et al. 2019

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Objectives/Hypothesis The current gold standard of therapy for adductor spasmodic dysphonia (AdSD) is injection of botulinum toxin A (BTX) in the adductor musculature. A surgical procedure could potentially offer more stable and long‐lasting voice quality. In this study, we report the long‐term results of endoscopic laser thyroarytenoid (TA) myoneurectomy versus BTX treatment in the same patients with AdSD. Study Design Retrospective case series. Methods Between July 2013 and September 2016, a total of 22 patients with AdSD were included. Voice outcomes were measured using the Voice Handicap Index and a Likert‐scale patient‐reported voice questionnaire. Data were obtained for each patient at four time points: preoperatively with and without BTX and twice postoperatively at 3 months (short term) and 12 months (long term). Results No statistically significant differences were found between voice outcome after BTX injection and the short‐ and long‐term postoperative voice outcomes for the group as a whole. During postoperative follow‐up, 10 of the 22 patients (45%) needed a second procedure after an average of 18 months (interquartile range, 13–22 months) due to recurrence of their original voice problem. Conclusions The TA myoneurectomy showed encouraging results, comparable to BTX after follow‐up of 12 months for the group as a whole. However, after good results initially, voice deterioration was seen in 45% of the patients who all underwent a second procedure. These preliminary results provide important insights into the value of TA myoneurectomy as a potential definite treatment for a select group of patients with AdSD. Further research might explore long‐term results after revision surgery. Level of Evidence 4 Laryngoscope, 130:741–746, 2020

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“…5,6 Patients generally showed improvement in voice outcomes for 16 to 18 weeks after BoNTA treatments and needed repeated injections every 3 to 6 months. 8,9 However, BoNTA treatment showed varying degrees of success in patients depending on the individual BoNTA doses injected into the laryngeal musculature. 8 Additionally, a meta-analysis of BoNTA treatment in AdSD suggested that methodological limitations and the lack of standardisation in BoNTA efficacy research could contribute to the significant variation in treatment response among patients.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing long‐term treatment response to botulinum toxin injection for spasmodic dysphonia

Kang

Lee

Choi

et al. 2020

Clinical Otolaryngology

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Objective The purpose of this study was to evaluate the outcomes of long‐term botulinum toxin type A (BoNTA) treatment for adductor spasmodic dysphonia (AdSD) and to determine the factors predictive of treatment response by investigating dose stability and average intervals. Design Retrospective cohort study. Setting Academic tertiary medical centre. Exposures A total of 470 patients with adductor spasmodic dysphonia, who received electromyography‐guided BoNTA injections over 12 years, were retrospectively enrolled in this study. Main Outcomes and Measures The patients’ demographic data, baseline voice dynamics and treatment profiles (dose, frequency and intervals) were evaluated. Factors correlating with the dose adjustment ratio (number of increasing dosing/total number of BoNTA toxin injections) and changes in intervals between injections were statistically analysed. Results A total of 122 patients, who received ≥ 4 injections and whose average treatment interval was < 240 days, were finally evaluated. Of them, 115 (94.3%) were female and seven (5.7%) were male, and the mean age at initial treatment was 34.89 ± 13.07 and 41.14 ± 12.71 years, respectively. On average, patients received 18.00 ± 13.33 injections (1.67 ± 0.60 U/injection) to alternating unilateral vocal folds. The treatment period was 65.07 ± 43.28 months and the mean interval between injections was 4.16 ± 1.28 months. The mean dose adjustment ratio among patients who received ≥ 4 injections was 0.15 ± 0.13, and dose changes occurred 4.36 times/patient. The patients’ age and gender significantly affected the treatment response, where younger or female patients showed greater dosing variability and shorter intervals between injections. However, the baseline voice dynamics (voice handicap index, fundamental frequency, jitter, shimmer, noise‐to‐harmonic ratio, maximum phonation time and degree of voice breaks) did not predict the dose adjustment ratio or interval changes. In addition, patients with fluctuating doses showed lower age and higher VHI subscale scores, and patients with short‐treatment interval (< 100 days) showed higher SDF0. Conclusions Almost all patients received stable low doses of BoNTA over time, irrespective of the baseline results. Patients’ age, gender and VHI scores were correlated with poor treatment responses, such as frequent dose changes and shorter intervals between injections.

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Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients: A Systematic Review

Cited by 22 publications

References 48 publications

Post‐treatment clinical course following botulinum toxin injection therapy for adductor spasmodic dysphonia: Analysis of data from a placebo‐controlled, randomized, double‐blinded clinical trial in Japan

Post‐treatment clinical course following botulinum toxin injection therapy for adductor spasmodic dysphonia: Analysis of data from a placebo‐controlled, randomized, double‐blinded clinical trial in Japan

Adductor spasmodic dysphonia: Botulinum toxin a injections or laser thyroarytenoid myoneurectomy? A comparison from the patient perspective

Factors influencing long‐term treatment response to botulinum toxin injection for spasmodic dysphonia

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