Efficacy of Botulinum A Injection to the Laryngeal Adductor Compartment for Treatment of Cough

Abstract

ObjectivesStudies examining electromyography (EMG)‐guided laryngeal onobotulinumtoxinA (BTxA) injection for chronic cough reveal promising efficacy, however, are limited by small cohorts and absent quantifiable outcomes. It further remains unclear if pulmonary disease limits efficacy, or if vagal motor neuropathy prognosticates response. We hypothesize BTxA injection results in qualitative improvement in cough, decrease in Cough Severity Index (CSI), no change in Voice Handicap Index‐10 (VHI‐10), and complication rates comparable to historical data. We also examine the correlation of pulmonary comorbidities and vocal fold hypomobility with treatment efficacy.Study DesignRetrospective review.MethodsCharts for patients receiving percutaneous adductor compartment BTxA injection for cough were reviewed for the binary outcome of patient‐reported presence or absence of improvement. Generalized estimating equations regression models were used to analyze the change in CSI (ΔCSI) and the correlation of ΔCSI with qualitative outcomes. Multivariable analyses were used to examine correlation of vocal fold hypomobility and pulmonary disease with qualitative outcomes and ΔCSI.ResultsForty‐seven patients underwent 197 BTxA injections from June 2012 to June 2022. A statistical proportion of 0.698 (0.599–0.813, p < 0.0001) or 69.8% of injections resulted in subjective improvement. Mean ΔCSI was −2.12 (0.22–4.02, p < 0.05), indicating overall improvement. With and without subjective improvement, estimated ΔCSI was −4.43 and +2.68, respectively (p < 0.0001). VHI‐10 did not change (0.69, p = 0.483). Neither pulmonary disease nor vocal fold hypomobility correlated with subjective improvement or ΔCSI. Dysphagia occurred following 15 (7.6%) injections with no aspiration pneumonia or hospitalization.ConclusionsBTxA injection to the laryngeal adductors may effectively treat cough with limited risk for serious complications.Level of Evidence4 Laryngoscope, 2023

The Therapeutic Landscape in Chronic Cough

“…Transient sensations of globus and soreness at the site of inject were the main adverse effects. Laryngeal botulin toxin injections have also been reported to produce improvements in series of patients in clinical care, but no controlled studies have been performed [ 41 ]. The broad safety of these interventions and duration of any effect currently remains unclear.…”