Evidence for the effectiveness of botulinum toxin for spasmodic dysphonia from high-quality research designs Article First Online: 14 June 2007 Received: 01 January 2007 Accepted: 05 May 2007 DOI:
Cite this article as: Watts, C., Truong, D. & Nye, C. J Neural Transm (2008) 115: 625. doi:10.1007/s00702-007-0757-x Summary
The practice of evidence-based medicine promotes use of the knowledge ascertained from high quality research designs. The objective of this review was to determine what evidence has been provided from high quality research designs (e.g., randomized control trials or high quality prospective, matched group cohort studies), through December of 2006, relative to the effectiveness of botulinum toxin for treating spasmodic dysphonia. Results of the review indicated that no new high quality (Class I or Class II) studies have been published since 2001. One Class I study has been published since 1973, which found significant treatment effects for acoustic and perceptual variables of vocal function. Four Class II studies have been published during this same time frame, all finding significant treatment effects, though the nature of studied factors was variable between investigations. Based on the quality of evidence scale used, botulinum toxin can be considered an effective treatment for adductor spasmodic dysphonia.
Keywords: Botulinum toxin; spasmodic dysphonia
Correspondence: Christopher R. Watts, Department of Communication Sciences and Disorders, James Madison University, MSC 4304, Harrisonburg, VA 22840, USA
References Adams, SG, Hunt, EJ, Irish, JC, Charles, DA, Lang, AE, Durkin, LC, Wong, DLH 1995 Comparison of botulinum toxin injection procedures in adductor spasmodic dysphonia J Otolaryngol 24 345 351 PubMed Google Scholar Ali, S, Thomassen, M, Schulz, G, Hosey, L, Varga, M, Ludlow, C, Braun, A 2006 Alterations in CNS activity induced by botulinum toxin treatment in spasmodic dysphonia: an H 2 15O PET study J Speech Lang Hear Res 49 1127 1146 PubMed CrossRef Google Scholar Aronson, A 1990Clinical voice disorders: an interdisciplinary approach Thieme New York Google Scholar Bielamowicz, S, Bidus, K, Squire, S, Ludlow, C 2001 Assessment of posterior cricoarytenoid botulinum toxin injections in patients with abductor spasmodic dysphonia Ann Otol Rhinol Laryngol 110 406 412 PubMed Google Scholar Bielamowicz, S, Ludlow, CL 2000 Effects of botulinum toxin on pathophysiology in spasmodic dysphonia Ann Otol Rhinol Laryngol 109 194 203 PubMed Google Scholar Blitzer, A, Brin, M, Stewart, C 1998 Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients Laryngoscope 108 1435 1441 PubMed CrossRef Google Scholar Blitzer, A, Brin, MF 1991 Laryngeal dystonia: a series with botulinum toxin therapy Ann Otol Rhinol Laryngol 100 85 89 PubMed Google Scholar Blitzer, A, Sulica, L 2001 Botulinum toxin: basic science and clinical uses in otolaryngology Laryngoscope 111 218 226 PubMed CrossRef Google Scholar Brin, M, Blitzer, A, Stewart, C, Diamond, B, Pogoda, J 2001 Botulinum toxin type A for adductor spasmodic dysphonia (laryngeal dystonia): double-blind placebo-controlled assessment of dose and technique Neurology 56 A346 Google Scholar Cannito, M 2001 Neurological aspects of spasmodic dysphonia Vogel, D Cannito, M eds. Treating disordered speech motor control Pro-Ed Austin Google Scholar Cannito, M, Johnson, P 1981 Spastic dysphonia: a continuum disorder J Commun Disord 14 215 223 PubMed CrossRef Google Scholar Duffy, J, Yorkston, K 2003 Medical interventions for spasmodic dysphonia and some related conditions: a systematic review J Med Speech Pathol 11 ix lviii Google Scholar Drost, H, Baatenburg de Jong, R 1998 Unilateral versus bilateral botulinum toxin injections in adductor spasmodic dysphonia Ann Otol Rhinol Laryngol 107 280 284 PubMed Google Scholar Fisher, K, Scherer, R, Swank, P, Giddens, C, Patten, D 1999 Electroglottographic tracking of phonatory response to Botox J Voice 13 203 209 PubMed CrossRef Google Scholar Ford, C, Bless, D, Lowery, J 1990 Indirect laryngoscopic approach for injection of botulinum toxin in spasmodic dysphonia Otolaryngol Head Neck Surg 103 752 758 PubMed Google Scholar Ford, C, Bless, D, Patel, N 1992 Botulinum toxin treatment of spasmodic dysphonia: techniques, indications, efficacy J Voice 6 370 376 CrossRef Google Scholar Goodin, D, Frohman, E, Garmany, G, Halper, J, Likosky, W, Lublin, F, Silberberg, D, Stuart, W, van den Noort, S 2002 Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines Neurology 58 169 178 PubMed Google Scholar Green, D, Ward, P, Berke, G, Gerratt, B 1992 Point-touch technique of botulinum toxin injection for the treatment of spasmodic dysphonia Ann Otol Rhinol Laryngol 101 883 887 PubMed Google Scholar Haslinger, B, Erhard, P, Dresel, C, Castrop, F, Roettinger, M, Ceballos-Baumann, A 2005 “Silent event-related” fMRI reveals reduced sensorimotor activation in laryngeal dystonia Neurology 22 1562 1569 CrossRef Google Scholar Hillel, A 2001 The study of laryngeal muscle activity in normal human subjects an din patients with laryngeal dystonia using multiple fine-wire electromyography Laryngoscope 111 1 47 PubMed CrossRef Google Scholar Hirano, S, Kojima, H, Naito, Y, Tateya, I, Shoji, K, Kaneko, K, Inoue, M, Nishizawa, S, Konishi, J 2001 Cortical dysfunction of the supplementary motor area in a spasmodic dysphonia patient Am J Otolaryngol 22 219 222 PubMed CrossRef Google Scholar Langeveld, T, Edgar, H, Jeroen, J, Van Rossum, M, Zwinderman, A, Baatenburg, R 2001 Evaluation of voice quality in adductor spasmodic dysphonia before and after botulinum toxin treatment Ann Otol Rhinol Laryngol 110 627 634 PubMed Google Scholar Ludlow, C, Bagley, J, Yin, S, Koda, J 1992 A comparison of injection techniques using botulinum toxin injection for treatment of the spasmodic dysphonia J Voice 6 380 386 CrossRef Google Scholar Lundy, D, Ling Lu, F, Casiano, R, Xue, J 1998 The effect of patient factors on response outcomes to botox treatment for spasmodic dysphonia J Voice 4 460 466 CrossRef Google Scholar Maronian, C, Waugh, P, Robinson, L, Hillel, A 2004 Tremor laryngeal dystonia: treatment of the lateral cricoarytenoid muscle Ann Otol Rhinol Laryngol 113 349 355 PubMed Google Scholar Mehta, R, Goldman, S, Orloff, L 2001 Long-term therapy for spasmodic-dysphonia: acoustic and aerodynamic outcomes Arch Otolaryngol Head Neck Surg 127 393 399 PubMed Google Scholar Papathanasiou, I, MacDonald, L, Whurr, R, Brookes, G, Jahanshahi, M 1997 Perceived stigma among patients with spasmodic dysphonia J Medic Speech-Language Pathol 5 251 261 Google Scholar Rhew, K, Fiedler, DA, Ludlow, CL 1994 Technique for injection of botulinum toxin through the flexible nasolaryngoscope Otolaryngol Head Neck Surg 111 787 794 PubMed CrossRef Google Scholar Rodriguez, A, Ford, C, Bless, D, Harmon, R 1994 Electromyographic assessment of spasmodic dysphonia patients prior to botulinum toxin injection Electromyography Clin Neurophysiol 34 403 407 Google Scholar Sapienza, C, Cannito, M, Murry, T, Branski, R, Woodson, G 2002 Acoustic variations in reading produced by speakers with spasmodic dysphonia pre-botox injection and within early stages of post-botox injection J Speech Lang Hear Res 45 830 843 PubMed CrossRef Google Scholar Schonweiler, R, Wohlfarth, K, Dengler, R, Ptok, M 1998 Supraglottal injection of botulinum toxin type A in adductor spasmodic dysphonia with both intrinsic and extrinsic hyperfunction Laryngoscope 108 55 63 PubMed CrossRef Google Scholar Strong, B, DelGaudio, J, Hapner, E, Johns, M 2005 Safety of simultaneous bilateral botulinum toxin injections for abductor spasmodic dysphonia Arch Otolaryngol Head Neck Surg 131 793 795 CrossRef Google Scholar Truong, D, Rontal, M, ROlnick, M, Aronson, A, Mistura, K 1991 Double-blind controlled study of botulinum toxin in adductor spasmodic dysphonia Laryngoscope 101 630 634 CrossRef Google Scholar Watts, C, Nye, C, Whurr, R 2006 Botulinum toxin for treating spasmodic dysphonia (laryngeal dystonia): a systematic Cochrane review Clin Rehabil 20 112 122 PubMed CrossRef Google Scholar Wong, D, Irish, J, Adams, S, Durkin, L, Hunt, E 1995 Laryngeal image analysis following botulinum toxin injections in spasmodic dysphonia J Otolaryngol 24 64 68 PubMed Google Scholar Whurr, R, Lorch, M, Fontana, H, Brookes, G, Lees, A, Marsden, CD 1993 The use of botulinum toxin in the treatment of adductor spasmodic dysphonia J Neurol Neurosurg Psychiatry 56 526 530 PubMed CrossRef Google Scholar Whurr, R, Lorch, M, Lindsay, M, Brookes, G, Marsden, C 1998 Psychological function in spasmodic dysphonia before and after treatment with botulinum toxin J Med Speech Language Pathol 2 81 91 Google Scholar Zwirner, P, Murry, T, Swenson, M, Woodson, GE 1991 Acoustic changes in spasmodic dysphonia after botulinum toxin injection J Voice 5 78 84 CrossRef Google Scholar