Outcomes of Onabotulinum Toxin A Treatment for Adductor Spasmodic Dysphonia and Laryngeal Tremor

Patel, Priyesh N.; Kabagambe, Edmond K.; Starkweather, Jennifer C.; Keller, Matthew; Gamsarian, Vahram; Lee, Jane; Kulkarni, Vishnutheertha; Garrett, C. Gaelyn; Francis, David O.

doi:10.1001/jamaoto.2017.3088

Cited by 15 publications

(17 citation statements)

References 53 publications

(177 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The primary treatment for patients with adductor spasmodic dysphonia (ADSD) and ADSD with a tremor is repeated injections of the thyroarytenoid (TA) muscles with botulinum toxin type A (Botox), a polypeptide produced by the bacteria Clostridium botulinum. [1][2][3][4][5] Spasm of the thyroarytenoid muscles within the larynx is responsible for the dysphonia, and the botulinum toxin works by inhibiting acetylcholine release from presynaptic terminals leading to the TA muscles, thus producing a neuromuscular blockade. 6 The dose-dependent Botox injection essentially weakens the neuronal signal to the TA muscles, thereby reducing the spastic activity and improving the patient's voice symptoms.…”

Section: Introductionmentioning

confidence: 99%

Unilateral versus bilateral botulinum toxin injections in adductor spasmodic dysphonia in a large cohort

Dharia

Bielamowicz

2019

The Laryngoscope

View full text Add to dashboard Cite

Objectives/Hypothesis: The primary treatment of adductor spasmodic dysphonia is repeated injections of botulinum toxin type A (Botox) into the thyroarytenoid muscles. Dosing can be performed into either one or both thyroarytenoid muscles. The objective of this study was to evaluate the treatment effect and side effect profile across a large number of injections. This study was performed previously in 2002 on 45 patients. Study Design: Individual cohort study. Methods: This is retrospective study of all patients with adductor spasmodic dysphonia with and without tremor treated by the senior laryngologist at George Washington University. In the current study, 272 patients (214 females and 58 males) were included in the current analysis. Duration of effects and side effects (vocal weakness and liquid dysphagia) were recorded into a database for each patient after each injection. These data were analyzed using χ 2 analysis. Results: A total of 4,023 injections (2,708 bilateral and 1,315 unilateral) were evaluated in this study. Optimal effect duration (≥3 months) was more commonly seen in the bilaterally injected patients (55%) compared to the unilaterally injected patients (47%) (P = .0001). Optimal side effect duration (≤2 weeks) was better for the unilaterally injected patients (77%) compared to the bilaterally injected patients (73%) (P = .023). Having both optimal effect and side effect in the same injection was more commonly seen in the bilaterally injected patients (36%) compared to the unilaterally injected patients (33%) (P = .0228). Conclusions: This study shows that bilateral injections of Botox are more effective in producing optimal effect/side effect profiles.

show abstract

Section: Introductionmentioning

confidence: 99%

Unilateral versus bilateral botulinum toxin injections in adductor spasmodic dysphonia in a large cohort

Dharia

Bielamowicz

2019

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…In our study, strap muscle injections only occurred over the thyroid lamina in an infrahyoid location; we did not perform suprahyoid injections. Another recent and large study extensively compared LBTX outcomes among VT, and adductor and abductor spasmodic dysphonia patients . Although they did consider vertical and horizontal tremor components, strap muscle injection was not included in their study.…”

Section: Discussionmentioning

confidence: 99%

“…Though this introduces the risk of recall bias, the fact that VHI‐10 and overall CAPE‐V scores both show improvement alongside subjective scores—albeit to a non–statistically significant degree—suggests a consistent and real response when comparing TA+S injections to TA alone in patients with both tremor types. Previous studies have used patient diaries to better ascertain peak benefit; however, CAPE‐V scores must be obtained in person. Asking patients to come into clinic during peak benefit could incur time and cost benefits, as patients would not likely be ready for their subsequent injections and this would require additional clinic visits.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, VT is not always limited to the intrinsic muscles of the larynx, but may also involve extrinsic laryngeal, pharyngeal, and palatal musculature . There are two well‐described subtypes of VT: horizontal vocal tremor and vertical vocal tremor . The former describes oscillatory movements in the horizontal plane, which are predominantly mediated by the thyroarytenoid and lateral cricoarytenoid muscles.…”

Section: Introductionmentioning

confidence: 99%

“…The therapeutic decision tree for VT is complex, with options that include voice therapy, medical therapy, vocal fold augmentation, or laryngeal botulinum toxin injection (LBTX), with roles for speech pathologists, neurologists, and laryngologists . There is, however, a growing body of evidence for the role of LBTX therapy . Although treatment paradigms exist describing differing injection sites for both horizontal and vertical tremor, namely thyroarytenoid muscle injections for horizontal tremor and strap muscle injections for vertical tremor, there is little published on the outcomes of these injection sites based on these characteristics of vocal tremor .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Laryngeal Botulinum Toxin Injection for Vocal Tremor: Utility of Concurrent Strap Muscle Injection

et al. 2018

View full text Add to dashboard Cite

Objectives/Hypothesis Vocal tremor is a neurologic disorder that can be treated with laryngeal botulinum toxin injections (LBTX). We sought to describe our experience with thyroarytenoid and concurrent strap muscle injection. Study Design Retrospective chart review. Methods A chart review was performed of all patients with a primary diagnosis of vocal tremor treated with LBTX from 2012 through 2017. Results Twenty‐one patients were included (mean age 69 years, 100% female). Thirteen patients (62%) had a minor component of spasmodic dysphonia in addition to their tremor. Fourteen patients had vertical and horizontal components to their tremor, and two had horizontal tremor alone. The remaining five patients did not have clear characterization of their tremor. A total of 49 injections were reviewed (25 thyroarytenoid [TA], 24 thyroarytenoid and strap muscle [TA+S]), and patients reported subjective voice benefit with 48 (96%) of these (92% TA, 100% TA+S). When available, the postprocedural change from baseline Voice Handicap Index‐10 and Consensus Auditory Perceptual Evaluation of Voice scores were calculated (mean overall: −1.9, −7.8; TA: −2.7, −3.5; TA+S: −1.4, −10.3, respectively). Subjective patient improvement ratings (scale 0%–100%) were obtained for 46 injections, with a mean of 70% improvement per injection. Of patients with both horizontal and vertical tremor, outcomes were improved with TA+S injection versus TA alone (mean improvement 74% vs. 35%, P < .005). Conclusions There is utility in the characterization of vertical and horizontal components of vocal tremor. Patients with both appear to have increased benefit with injection of strap muscles in addition to thyroarytenoid muscles. Level of Evidence 4 Laryngoscope, 129:1433–1437, 2019

show abstract

Characterizing the Normative Voice Tremor Frequency in Essential Vocal Tremor

Paige

Hopewell

Gamsarian

et al. 2018

JAMA Otolaryngol Head Neck Surg

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Essential vocal tremor (EVT) is a neurologic voice disorder characterized by periodic fluctuations in pitch and loudness that can hinder intelligibility. Defining the normative range of vocal tremor frequency may assist in diagnosis and provide insight into disease mechanisms. OBJECTIVE To characterize the normative voice tremor frequency in EVT (in hertz). DESIGN, SETTING, AND PARTICIPANTS Cross-sectional observational study of 160 patients with EVT. The setting was a tertiary voice center. Participants were identified from a database of consecutive patients diagnosed as having laryngeal movement disorders between January 1, 1990, and April 1, 2017. MAIN OUTCOMES AND MEASURES The following 3 methods measured the frequency of tremor experienced by patients with EVT: perceptual method, computerized peak detection method, and laryngeal electromyography method. Within-person and population-level tremor frequencies were compared across modalities to assess measurement reliability and consistency and to characterize the normal distribution of tremor frequencies in this population. RESULTS Among 160 participants (median age, 70 years; interquartile range [IQR], 64-77 years; 90.6% female [n = 145]), the median frequency of EVT was consistently between 4 and 5 Hz across all 3 methods (perceptual, 4.8 Hz [IQR, 4.4-5.5 Hz]; computerized peak detection, 4.6 Hz [IQR, 4.2-5.0 Hz]; and laryngeal electromyography, 4.3 Hz [IQR, 3.8-5.0 Hz]). The mean in-person differences between each measurement method were not clinically meaningful (range, 0.1-0.5 Hz). Including all interquartile ranges across measurement modalities, the normative tremor frequency range for EVT was 3.8 to 5.5 Hz. CONCLUSIONS AND RELEVANCE To our knowledge, this is the largest study to date to characterize the normal frequency of tremor in patients with EVT. The normative frequency of EVT (range, 3.8-5.5 Hz) falls within a much narrower range than previously reported. Those whose frequency is outside this range may still have EVT but should be carefully evaluated for potential other causes of vocal tremor. Defining characteristics of EVT may aid appropriate diagnosis and improve understanding of this disease.

show abstract

Outcomes of Onabotulinum Toxin A Treatment for Adductor Spasmodic Dysphonia and Laryngeal Tremor

Cited by 15 publications

References 53 publications

Unilateral versus bilateral botulinum toxin injections in adductor spasmodic dysphonia in a large cohort

Unilateral versus bilateral botulinum toxin injections in adductor spasmodic dysphonia in a large cohort

Laryngeal Botulinum Toxin Injection for Vocal Tremor: Utility of Concurrent Strap Muscle Injection

Characterizing the Normative Voice Tremor Frequency in Essential Vocal Tremor

Contact Info

Product

Resources

About