Botulinum toxin type A: an effective treatment to restore phonation in laryngectomized patients unable to voice.

Abstract

We evaluated the efficacy of Botulinum toxin type A (BTXA) as an alternative to surgical intervention to facilitate phonation in 34 laryngectomized patients (31 males and 3 women) who were unable to produce tracheoesophageal voice because of spasm of the middle and inferior pharyngeal constrictor muscles (PCM). EMG was recorded to confirm activity in these muscles during attempted vocalization. Parapharyngeal nerve block (Carbocaine 2%, 5 cc) was used to demonstrate short-term fluent voice after relaxation of the pharyngeal constrictor muscle. At a later occasion, 100 U of Botox (Allergan) in ten patients and 50 U in two patients were injected unilaterally at one location in the PCM percutaneously under EMG guidance. All patients then underwent a voice therapy program. In 11 out of 12 patients an improvement of phonation was evident after 24-48 h and it was long lasting. This result was also seen in a patient previously myotomized without improvement. Only one patient needed to be reinjected every 3 months. At a follow-up after 3 months the EMG recorded in four patients showed a low-amplitude or complete absence of activity in the treated muscle. No side effects developed. BTX therapy, especially when associated with the speech therapy, is efficacious in restoring voice to laryngectomees who are unable to voice because of spasm of the PCMs. Our results confirm previous reports. This method is our approach of choice in managing PCM spasm because it is non-invasive, not painful, has few or no side effects, and is frequently long-lasting.

• Authors: Luigi Bartolomei, Sandro Zambito Marsala, Gian Paolo Pighi, Valentina Cristofori, Giuseppe Pagano, Massimo Pontarin, Manuela Gioulis, Corrado Marchini
• Journal: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (Neurol Sci) Vol. 32 Issue 3 Pg. 443-7 (Jun 2011) ISSN: 1590-3478 [Electronic] Italy
• PMID: 21479612 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Adult
• Aged
• Aged, 80 and over
• Botulinum Toxins, Type A (administration & dosage, therapeutic use)
• Clostridium botulinum (chemistry)
• Dysphonia (drug therapy, etiology, rehabilitation)
• Female
• Humans
• Laryngectomy (adverse effects, rehabilitation)
• Male
• Middle Aged
• Nerve Block (methods)
• Neuromuscular Agents (administration & dosage)
• Pharyngeal Muscles (drug effects, physiopathology)
• Phonation (drug effects, physiology)
• Spasm (drug therapy, etiology, rehabilitation)
• Speech, Esophageal (methods)