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The point-touch technique for botulinum toxin injection in adductor spasmodic dysphonia: quality of life assessment

Published online by Cambridge University Press:  27 April 2011

S Morzaria  and
E J Damrose
S Morzaria*
Affiliation:
Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, California, USA
E J Damrose
Affiliation:
Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, California, USA
*
Address for correspondence: Dr Sanjay Morzaria, Clinical Instructor, University of British Columbia, Department of Otolaryngology-Head and Neck Surgery, 103–8556 120th Street, Surrey, BC V3W 3N5, Canada Fax: (778) 565 3249, E-mail: Morzaria@yahoo.com
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Abstract

Background:

Botulinum toxin injection under electromyographic guidance is the ‘gold standard’ for adductor spasmodic dysphonia treatment. The point-touch technique, an alternative injection method which relies on anatomical landmarks, is cheaper, quicker and more accessible, but has not yet gained widespread acceptance due to concerns about patient satisfaction.

Objective:

To assess swallowing and voice-related quality of life following point-touch botulinum toxin injection in adductor spasmodic dysphonia patients.

Setting:

Stanford University Voice and Swallowing Center.

Design:

Prospective case series (evidence level four).

Methods:

Consecutive adductor spasmodic dysphonia patients with a stable botulinum toxin dose–response relationship were recruited prospectively. The Eating Assessment Tool and Voice-Related Quality of Life questionnaires were completed pre-treatment and at 10 and 30 per cent completion of the injection cycle, respectively.

Results:

Thirty-seven patients completed follow up. The mean total botulinum toxin dose was 0.88 units. Pre-treatment Voice-Related Quality of Life questionnaire results reflected the burden of disease. Post-treatment Eating Assessment Tool and Voice-Related Quality of Life questionnaire results were collected at 2.53 and 7.84 weeks, respectively; the former showed an increase in dysphagia, albeit statistically insignificant, while the latter showed significantly improved scores (both domain and total).

Conclusion:

The point-touch technique is a viable alternative for botulinum toxin injection in the treatment of adductor spasmodic dysphonia.

Keywords

Spasmodic DysphoniaNeurologic AdductorQuality Of LifeLarynxBotulinum Toxins
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 7 , July 2011 , pp. 714 - 718
Copyright
Copyright © JLO (1984) Limited 2011

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Footnotes

Presented at the Canadian Society of Otolaryngology – Head and Neck Surgery Meeting, 23–26 May 2010, Niagara Falls, Ontario, Canada

References

1Sulica, L. Contemporary management of spasmodic dysphonia. Curr Opin Otolaryngol Head Neck Surg 2004;12:543–8CrossRefGoogle ScholarPubMed
2Blitzer, A, Brin, MF, Stewart, CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 1998;108:1435–41CrossRefGoogle ScholarPubMed
3Watts, C, Nye, C, Whurr, R. Botulinum toxin for treating spasmodic dysphonia (laryngeal dystonia): a systematic Cochrane review. Clin Rehabil 2006;20:112–22CrossRefGoogle ScholarPubMed
4Chang, C, Chabot, P, Walz, CM. A survey of current practices of physicians who treat adductor spasmodic dysphonia in the U.S. Ear Nose Throat J 2009;88:E18CrossRefGoogle ScholarPubMed
5Rodriquez, A, Ford, C, Bless, D, Harmon, R. Electromyographic assessment of spasmodic dysphonia patients prior to botulinum toxin injection. Electromyogr Clin Neurophysiol 1994;34:403–7Google ScholarPubMed
6Woo, P. Laryngeal electromyography is a cost-effective clinically useful tool in the evaluation of vocal fold function. Arch Otolaryngol Head Neck Surg 1998;124:472–6CrossRefGoogle ScholarPubMed
7Casserly, P, Timon, C. Botulinum toxin A injection under electromyographic guidance for treatment of spasmodic dysphonia. J Laryngol Otol 2008;122:52–6CrossRefGoogle ScholarPubMed
8Woodson, G. Clinical value of laryngeal EMG is dependent on experience of the clinician. Arch Otolaryngol Head Neck Surg 1998;124:476Google ScholarPubMed
9Rhew, K, Fiedler, DA, Ludlow, CL. Technique for injection of botulinum toxin through a flexible nasolaryngoscope. Otolaryngol Head Neck Surg 1994;111:787–94CrossRefGoogle ScholarPubMed
10Ford, C, Bless, DM, Lowery, JD. Indirect laryngoscopic approach for injection of botulinum toxin in spasmodic dysphonia. Otolaryngol Head Neck Surg 1990;103:752–8CrossRefGoogle ScholarPubMed
11Green, D, Berke, GS, Ward, PH, Gerratt, BR. Point-touch technique of botulinum toxin injection for the treatment of spasmodic dysphonia. Ann Otol Rhinol Laryngol 1992;101:883–7CrossRefGoogle ScholarPubMed
12Blitzer, A, Brin, MF, Fahn, S, Lovelace, RE. Clinical and laboratory characteristics of laryngeal dystonia: a study of 110 cases. Laryngoscope 1988;98:636–40Google ScholarPubMed
13Paniello, R, Barlow, J, Serna, JS. Longitudinal follow-up of adductor spasmodic dysphonia patients after botulinum toxin injection: quality of life results. Laryngoscope 2008;118:564–8CrossRefGoogle ScholarPubMed
14Hogikyan, N, Sethuraman, G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice 1999;13:557–69CrossRefGoogle ScholarPubMed
15Morzaria, S, Damrose, EJ. A comparison of the VHI, VHI-10 and V-RQOL for measuring the effect of Botox therapy in adductor spasmodic dysphonia. J Voice 2010; Oct 15 [epub ahead of print]Google ScholarPubMed
16Rubin, A, Wodchis, WP, Spak, C, Kileny, PR, Hogikyan, ND. Longitudinal effects of Botox injections on voice-related quality of life (V-RQOL) for patients with adductory spasmodic dysphonia: part II. Arch Otolaryngol Head Neck Surg 2004;130:415–20CrossRefGoogle ScholarPubMed
17Paniello, R, Edgar, JD, Perlmutter, JS. Vocal exercise versus voice rest following botulinum toxin injections: a randomized crossover trial. Ann Otol Rhinol Laryngol 2009;118:759–63CrossRefGoogle ScholarPubMed
18Hogikyan, N, Wodchis, WP, Spak, C, Kileny, PR. Longitudinal effects of botulinum toxin injections on voice-related quality of life (V-RQOL) for patients with adductory spasmodic dysphonia. J Voice 2001;15:576–86CrossRefGoogle ScholarPubMed
19Braden, M, Johns, MM 3rd, Klein, AM, Delgaudio, JM, Gilman, M, Hapner, ER. Assessing the effectiveness of botulinum toxin injections for adductor spasmodic dysphonia: clinician and patient perception. J Voice 2010;24:242–9CrossRefGoogle ScholarPubMed
20Hogikyan, ND, Wodchis, WP, Terrell, JE, Bradford, CR, Esclamado, RM. Voice-related quality of life (V-RQOL) following type I thyroplasty for unilateral vocal fold paralysis. J Voice 2000;14:378–86CrossRefGoogle ScholarPubMed
21Belafsky, P, Mouadeb, DA, Rees, CJ, Pryor, JC, Postma, GN, Allen, J et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 2008;117:919–24CrossRefGoogle ScholarPubMed