Indications for the Use of Botox in Laryngology: A Review

Abstract

Objective: Botox causes chemical denervation by inhibiting release of acetylcholine from nerve terminals. In laryngology, Botox was initially introduced in patients with spasmodic dysphonia. Since then, its role has expanded to other disorders of laryngeal muscle hyperfunction. We aim to identify expanded indications of Botox in laryngology and review the literature. Method: We performed a retrospective review of all patients treated with Botox injection in the senior author’s (PW) laryngology practice from 1998 to 2010. Indications were categorized and outcomes were analyzed. Results: A total of 257 patients received laryngeal injections of Botox. Of these, 57 patients (22.2%) were indicated for reasons other than spasmodic dysphonia. Twenty-nine (50.9%) were female and 28 (49.1%) were male. Age range was 15 to 72 years with a mean of 40 years. Eighteen (31.6%) patients were treated for paradoxical vocal fold motion, 14 (24.56%) were treated for contact granuloma, and 10 (17.54%) were treated for vocal fold paralysis with aberrant re-innervation. Other indications included tremor, loud voice, mutational voice disorder, and spasticity. Twenty-nine (49.15%) patients benefited from multiple injections. Conclusion: The use of Botox for the intrinsic musculature of the larynx can be considered for a wide spectrum of pathology involving vocal fold hyperfunction.