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. 2009 Oct 24:5:20.
doi: 10.1186/1746-160X-5-20.

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

Tahwinder Upile  1 , Behrad Elmiyeh, Waseem Jerjes, Vyas Prasad, Panagiotis Kafas, Jesuloba Abiola, Bryan Youl, Ruth Epstein, Colin Hopper, Holger Sudhoff, John Rubin
Affiliations

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

Tahwinder Upile et al. Head Face Med. .

Abstract

Objectives: In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration.

Method and materials: Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven.

Results: Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections.

Conclusion: Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia.

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Figures

Figure 1
Figure 1
Monitor showing NPS score of 2.
Figure 2
Figure 2
Monitor showing NPS score of 9.
Figure 3
Figure 3
Graph of voice score and laterality. Showing a statistically significant trend for the unilateral injection group to have a better voice score over the interval between visits.
Figure 4
Figure 4
Graph of episodes of complications and laterality of injections. Showing that the unilateral injections group experience no total voice loss and are otherwise not statistically significantly different to the bilateral injection group.
Figure 5
Figure 5
Graph showing the average interval between presentations and the laterality of injections. The unilateral injection group has a trend to a longer period between visits.
Figure 6
Figure 6
Schematic summary showing average values for voice score (VS), neurophysiological score (NPS) and time intervals between attendance for injection in the unilateral and bilateral injection group.
See this image and copyright information in PMC

References

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