Using botulinum toxin therapy in the laryngopharynx

Abstract

Now generally accepted as the gold-standard treatment of the symptoms of spasmodic dysphonia, botulinum toxin has become a powerful tool in the treatment of a variety of disorders affecting the laryngopharynx. A high degree of efficacy and reproducible effects and a low incidence of adverse effects make this an excellent drug to help control hyperactive and hyperkinetic behavior of the laryngeal musculature. In addition to spasmodic dysphonia, there are a number of other hyperactive disorders that affect the quality of speech and voicing. These include the following: tremor, stuttering, vocal tics, ventricular dysphonia, and others. By applying carefully directed injection of botulinum toxin into various laryngeal muscles, many of the symptoms of these disorders can be controlled. Botulinum toxin injections are effective for hyperkinetic conditions and can help diminish the need for systemic medications, time-consuming and often ineffective speech therapy, and the psychological stress of having a voicing disorder. Similarly, botulinum toxin has been used in the larynx by various groups to help “rebalance” the opposing laryngeal adductory and abductory muscles and diminish abusive contact that leads to nodules and granuloma formation. Used as an adjunct in the healing process, botulinum toxin has been helpful in decreasing scar formation and synechiae. In addition, botulinum toxin therapy has emerged as beneficial for the treatment of hyperactive cricopharyngeal muscular contraction in swallowing disorders and failed tracheo-esophageal speech.