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


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.


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


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.


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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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