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European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 2, pp 909–917 | Cite as

Botulinum toxin injection in laryngeal dyspnea

  • Virginie WoisardEmail author
  • Xuelai Liu
  • Marie Christine Arné Bes
  • Marion Simonetta-Moreau
Laryngology

Abstract

Data, regarding the use of botulinum toxin (BT-A) in laryngeal dyspnea, are scarce, coming from some cases reports in the literature, including Vocal fold paralysis, laryngeal dystonia, vocal cord dysfunction also called paradoxical motion of the vocal fold (PMVF), and post-neuroleptic laryngeal dyskinesia. There is no consensus regarding the muscles and the doses to inject. The aim of this study is to present a retrospective review of patients treated in our ENT Department by BT-A injection in this indication. This study is a retrospective study describing patients who underwent an injection of botulinum toxin for laryngeal dyspnea in the ENT Department from 2005 to 2015 years. The inclusion criteria were a dyspnea associated with a laryngeal dysfunction, confirmed by flexible fiberoptic nasopharyngolaryngoscopy. Information concerning the causes of the dyspnea, the botulinum toxin BT-A injections procedure, post-injection follow-up, and respiratory outcome were collected for all patients included. In the group of 13 patients included, the main cause identified as principal factor linked with the short breath was: a bilateral VF paralysis (Patel et al., Otolaryngol Head Neck Surg 130:686–689, 7), laryngeal dystonia (Balkissoon and Kenn, Semin Respir Crit Care Med 33:595–605, 2), Anxiety syndrome associated with unilateral vocal fold paralysis or asthma (Marcinow et al., Laryngoscope 124:1425–1430, 3), and an isolated asthma (Zwirner et al., Eur Arch Otorhinolaryngol 254:242–245, 1). Nine out of the thirteen patients were improved by the injections. A BT-A-induced stable benefit for four patients led them to stop the injections in the follow-up. Good outcome was observed in five other patients (main cause: bilateral VP paralysis), allowing a progressive lengthening of the delay between BT-A injections. Four patients did not report a positive risk/benefit ratio after BT-A injections; two of them (with bilateral VF paralysis), because of respiratory side effects and lack of benefit without the side effects for the two others. This failure of effect was not related with BT-A doses injected. This study provides support for using BT-A injections as a symptomatic treatment of periodic laryngeal dyspnea, regardless of the etiologic context. From our data, we suggest that a small starting dose (of around 4 U BT-A Botox®) could be enough for a first injection to obtain a good benefit. The target muscle should be determined by the EMG analysis.

Keywords

Botulinum toxin Laryngeal dystonia Paradoxical motion of the vocal fold Vocal cord dysfunction Laryngeal dyspnea Laryngeal paralysis 

Notes

Compliance with ethical standards

Conflict of interest

Virginie Woisard declares that she has no conflict of interest. Xuelai Liu declares that she has no conflict of interest. Marie Chistine Arné Bes declares that she has no conflict of interest. Marion Simonetta Moreau declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Zwirner P, Dressler D, Kruse E (1997) Spasmodic laryngeal dyspnea: a rare manifestation of laryngeal dystonia. Eur Arch Otorhinolaryngol 254:242–245CrossRefPubMedGoogle Scholar
  2. 2.
    Balkissoon R, Kenn K (2012) Asthma: vocal cord dysfunction (VCD) and other dysfunctional breathing disorders. Semin Respir Crit Care Med 33:595–605CrossRefPubMedGoogle Scholar
  3. 3.
    Marcinow AM, Thompson J, Chiang T et al (2014) Paradoxical vocal fold motion disorder in the elite athlete: experience at a large division I university. Laryngoscope 124:1425–1430CrossRefPubMedGoogle Scholar
  4. 4.
    Fève A, Angelard B, Fénelon G, Logak M, Guillard A, Lacau Saint-Guily J (1993) Postneuroleptic laryngeal dyskinesias: a cause of upper airway obstructive syndrome improved by local injections of botulinum toxin. Mov Disord 8:217–219CrossRefPubMedGoogle Scholar
  5. 5.
    Woo P, Mangaro M (2004) Aberrant recurrent laryngeal nerve reinnervation as a cause of stridor and laryngospasm. Ann Otol Rhinol Laryngol 113:805–808CrossRefPubMedGoogle Scholar
  6. 6.
    Azadarmaki R, Mirza N, Soliman AM (2009) Unilateral true vocal fold synkinesis presenting with airway obstruction. Ann Otol Rhinol Laryngol 118:587–591PubMedGoogle Scholar
  7. 7.
    Patel NJ, Jorgensen C, Kuhn J, Merati AL (2004) Concurrent laryngeal abnormalities in patients with paradoxical vocal fold dysfunction. Otolaryngol Head Neck Surg 130:686–689CrossRefPubMedGoogle Scholar
  8. 8.
    Vertigan AE, Theodoros DG, Gibson PG, Winkworth AL (2007) Voice and upper airway symptoms in people with chronic cough and paradoxical vocal fold movement. J Voice 21:361–383CrossRefPubMedGoogle Scholar
  9. 9.
    Blitzer A, Brin MF (1991) Laryngeal dystonia: a series with botulinum toxin therapy. Ann Otol Rhinol Laryngol 100:85–89CrossRefPubMedGoogle Scholar
  10. 10.
    Grillone GA, Blitzer A, Brin MF, Annino DJ Jr, Saint-Hilaire M-H (1994) Treatment of adductor laryngeal breathing dystonia with botulinum toxin type A. Laryngoscope 104:30–32CrossRefPubMedGoogle Scholar
  11. 11.
    Truong DD, Bhidayasiri R (2006) Botulinum toxin therapy of laryngeal muscle hyperactivity syndromes: comparing different botulinum toxin preparations. Eur J Neurol 13(Suppl 1):36–41CrossRefPubMedGoogle Scholar
  12. 12.
    Marion MH, Klap P, Perrin A, Cohen M (1992) Stridor and focal laryngeal dystonia. Lancet 22(339):457–458CrossRefGoogle Scholar
  13. 13.
    Ibrahim WH, Gheriani HA, Almohamed AA et al (2007) Paradoxical vocal cord motion disorder: past, present and future. Postgrad MedJ 83:164–172CrossRefGoogle Scholar
  14. 14.
    Maillard I, Schweizer V, Broccard A et al (2000) Use of botulinum toxin type A to avoid tracheal intubation or tracheostomy in severe paradoxical vocal cord movement. Chest 118:874–877CrossRefPubMedGoogle Scholar
  15. 15.
    Goldstein R, Bright J, Jones SM, Niven RM (2007) Severe vocal cord dysfunction resistant to all current therapeutic interventions. Respir Med 101:857–858CrossRefPubMedGoogle Scholar
  16. 16.
    van Griethuysen J, Al Yaghchi C, Sandhu G (2012) Use of bilateral suture lateralisation technique in severe paradoxical vocal fold movement, allowing removal of long-term tracheostomy: case report. J Laryngol Otol 126:328–330CrossRefPubMedGoogle Scholar
  17. 17.
    Lekue A, García-López I, Santiago S, Del Palacio A, Gavilán J (2015) Diagnosis and management with botulinum toxin in 11 cases of laryngeal synkinesis. Eur Arch Otorhinolaryngol 272:2397–2402CrossRefPubMedGoogle Scholar
  18. 18.
    Marie JP, Navarre I, Lerosey Y, Magnier P, Dehesdin D, Andrieu Guitrancourt J (1998) Bilateral laryngeal movement disorder and synkinesia: value of botulism toxin. A propos of a case. Rev Laryngol Otol Rhinol (Bord) 119:261–264Google Scholar
  19. 19.
    Andrade Filho PA, Rosen CA (2004) Bilateral vocal fold paralysis: an unusual treatment with botulinum toxin. J Voice 18:254–255CrossRefPubMedGoogle Scholar
  20. 20.
    Ongkasuwan J, Courey M (2011) The role of botulinum toxin in the management of airway compromise due to bilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg 19:444–448CrossRefPubMedGoogle Scholar
  21. 21.
    Ekbom DC, Garrett CG, Yung KC et al (2014) Botulinum toxin injections for new onset bilateral vocal fold motion impairment in adults. Laryngoscope 120:758–763CrossRefGoogle Scholar
  22. 22.
    Benninger MS, Hanick A, Hicks DM (2016) Cricothyroid muscle botulinum toxin injection to improve airway for bilateral recurrent laryngeal nerve paralysis, a case series. J Voice 30:96–99CrossRefPubMedGoogle Scholar
  23. 23.
    Young DL, Halstead LA (2014) Pyridostigmine for reversal of severe sequelae from botulinum toxin injection. J Voice 28:830–834CrossRefPubMedGoogle Scholar
  24. 24.
    Fahn S (2011) Classification of movement disorders. Mov Disord 26:947–957CrossRefPubMedGoogle Scholar
  25. 25.
    Wolraich D, Vasile Marchis-Crisan C, Redding N, Khella SL, Mirza N (2010) Laryngeal tremor: co-occurrence with other movement disorders. ORL J Otorhinolaryngol Relat Spec 72:291–294CrossRefPubMedGoogle Scholar
  26. 26.
    Blitzer A, Crumley RL, Dailey SH et al (2009) Recommendations of the neurolaryngology study group on laryngeal electromyography. Otolaryngol Head Neck Surg 140:782–793CrossRefPubMedGoogle Scholar
  27. 27.
    Volk GF, Hagen R, Pototschnig C et al (2012) Laryngeal electromyography: a proposal for guidelines of the European Laryngological Society. Eur Arch Otorhinolaryngol 269:2227–2245CrossRefPubMedGoogle Scholar
  28. 28.
    Maronian NC, Robinson L, Waugh P et al (2004) A new electromyographic definition of laryngeal synkinesis. Ann Otol Rhinol Laryngol 113:877–886CrossRefPubMedGoogle Scholar
  29. 29.
    Woodson GE, Zwimer P, Murry T, Swenson M (1991) Use of fiberoptic laryngoscopy to assess patients with spasmodic dysphonia. J Voice 5:85–91CrossRefGoogle Scholar
  30. 30.
    Crumley RL (2000) Laryngeal synkinesis revisited. Ann OtolRhinol Laryngol 109:365–371CrossRefGoogle Scholar
  31. 31.
    Woisard-Bassols V, Alshehri S, Simonetta-Moreau M (2013) The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness. Eur Arch Otorhinolaryngol 270:805–815CrossRefPubMedGoogle Scholar
  32. 32.
    Ludlow CL (2011) Spasmodic dysphonia: a laryngeal control disorder specific to speech. J Neurosci 31:793–797CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Termsarasab P, Ramdhani RA, Battistella G, Rubien-Thomas E, Choy M, Farwell IM, Velickovic M, Blitzer A, Frucht SJ, Reilly RB, Hutchinson M, Ozelius LJ, Simonyan K (2015) Neural correlates of abnormal sensory discrimination in laryngeal dystonia. Neuroimage Clin 30(10):18–26Google Scholar
  34. 34.
    Kellman RM, Leopold DA (1982) Paradoxical vocal cord motion: an important cause of stridor. Laryngoscope 92:58–60CrossRefPubMedGoogle Scholar
  35. 35.
    Murray DM, Lawler PG (1998) Paradoxical vocal cord movement presenting as severe acute asthma requiring ventilator support. Anaesthesia 53:1006–1011CrossRefPubMedGoogle Scholar
  36. 36.
    Soli CG, Smally AJ (2005) Vocal cord dysfunction: an uncommon cause of stridor. J Emerg Med 28:31–33CrossRefPubMedGoogle Scholar
  37. 37.
    Ranoux D, Gury C, Fondarai J et al (2002) Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia. J Neurol Neurosurg Psychiatry 72:459–462PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Voice and Déglutition Unit, ENT DepartmentUniversitary Hospital of ToulouseToulouse Cedex 9France
  2. 2.Voice and Déglutition Unit, ENT DepartmentUniversitary Hospital of Toulouse and Chongqing Medical UniversityChongqingChina
  3. 3.Neurology Department, ALS and Neuromuscular Disease Reference CenterUniversitary Hospital of ToulouseToulouseFrance
  4. 4.Neurosciences Department, Toulouse University Hospital, Toulouse Neuroimaging CenterUniversity of Toulouse, Inserm UPSToulouseFrance

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