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Pharyngeal Motility Before and After Thyroarytenoid Muscle Botulinum Toxin Injection

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Abstract

Botulinum toxin type A (BTA) injection in intrinsic laryngeal musculature may result in dysphagia and consequent loss of quality of life (QOL) in a percentage of patients. This study aims to evaluate pharyngeal motility as a putative cause for this change in swallow quality in light of high-resolution manometry (HRM). Twenty patients (95% females, median age 66 years) underwent high-resolution manometry before and after BTA injection. Dysphagia was evaluated based on a QOL dedicated questionnaire (SWAL-QOL) before and after BTA injection. Pharyngeal motility at the topography of the vellum, epiglottis, and upper esophageal sphincter (UES) were recorded. Eleven (55%) subjects had worsened QOL after BTA injection. In patients with worsened QOL, UES extension decreased (p = 0.005), UES residual pressure increased (p = 0.02), UES basal pressure decreased (p = 0.04), and velopharynx contraction duration decreased (p = 0.04). UES residual pressure increased (p = 0.01), velopharynx peak pressure (p = 0.04) and upstroke (p = 0.007) decreased in patients with maintained QOL. There was no difference between groups when comparing pre-injection values. UES extension (p = 0.01) and UES maximum relaxation time (p = 0.03) was lower in the group with worsened QOL after BTA as compared to no change in QOL. Pharyngeal motility as measured by HRM was not a predictor for post procedure dysphagia and the changes in motility after BTA injection does not seem to be a strong contributor to dysphagia.

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Funding

Funding was provided by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

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Authors and Affiliations

  1. Department of Ear, Nose and Throat, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Pedro de Toledo 947, Sao Paulo, SP, 04038-002, Brazil

    Welber Chaves Mororó, Karine Valéria Gonçalves de Oliveira & Noemi Grigoletto De Biase

  2. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil

    Fernando Augusto Herbella

  3. Pontifícia Universidade Católica de São Paulo, Rua Monte Alegre 984, Sao Paulo, SP, 05014-901, Brazil

    Noemi Grigoletto De Biase

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  1. Welber Chaves Mororó
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  2. Fernando Augusto Herbella
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  3. Karine Valéria Gonçalves de Oliveira
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Correspondence to Welber Chaves Mororó.

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Mororó, W.C., Herbella, F.A., de Oliveira, K.V.G. et al. Pharyngeal Motility Before and After Thyroarytenoid Muscle Botulinum Toxin Injection. Dysphagia 35, 806–813 (2020). https://doi.org/10.1007/s00455-019-10086-x

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  • DOI: https://doi.org/10.1007/s00455-019-10086-x

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