Simultaneous Botox and Augmentation Injection Laryngoplasty in Patients With Adductor Spasmodic Dysphonia (ASD) and Tremor

Abstract

Although Botulinum Toxin (BOTOX) is effective for adductor spasmodic dysphonia (ASD) and essential vocal tremor (EVT), the side effects of breathy dysphonia may result in reluctance to pursue BOTOX treatment. We sought to improve results in selected elderly tremor patients with EVT and in professional voice users with ASD by simultaneous BOTOX injection and injection laryngoplasty using Hyaluronic acid (HA/Botox). Between July 2018 and March 2022, 23 simultaneous HA/Botox using LEMG control were done in eight patients with ASD and EVT (23 of 406 Botox Injections). All eight patients have previously reported unwanted side effects with poor voice results with Botox. Three patients had tremor with presbyphonia. Injection of Botox is performed first using LEMG control, followed by bilateral LEMG guided injection of 0.1 cc of HA. All HA/Botox injections were tolerated well. All patients reported some improved voice. Two patients did not go on to further HA injections while the others six have requested ongoing simultaneous HA/Botox injections. Patients with EVT and presbyphonia noted greater stability of voice than Botox alone. It lasted through the injection cycle. The professional voice users reported less breathy voice that allowed them to work right after the BOTOX injection. Simultaneous BOTOX injection with injection laryngoplasty using HA may be helpful in patients with tremor and presbyphonia. It also may be considered in professional voice users with ASD to reduce side effects of BOTOX.