van Esch Babette F, Wegner Inge, Stegeman Inge, Grolman Wilko
1 Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
2 Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
Otolaryngol Head Neck Surg. 2017 Feb;156(2):238-254. doi: 10.1177/0194599816675320. Epub 2016 Nov 1.
Objective The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid myotomy, thyroplasty, selective laryngeal adductor denervation-reinnervation, laryngeal nerve crush, and recurrent laryngeal nerve resection. Here, we present the first systematic review comparing the effect of botulinum toxin with surgical treatment among patients diagnosed with AdSD. Data Sources MEDLINE (PubMed), EMBASE, and the Cochrane Library. Methods Articles were reviewed by 2 independent authors, and data were compiled in tables for analysis of the objective outcome (voice expert evaluation after voice recording), the subjective outcome (patient self-assessment scores), and voice-related quality of life (Voice Health Index scores). Results No clinical trials comparing both treatment modalities were identified. Single-armed studies evaluated either the effect of botulinum toxin or surgical treatment. Thirteen studies reported outcomes after botulinum toxin treatment (n = 419), and 9 studies reported outcomes after surgical treatment (n = 585 patients). A positive effect of bilateral botulinum toxin injections was found for the objective voice outcome, subjective voice outcome, and quality of life. The duration of the beneficial effect ranged from 15 to 18 weeks. Surgical treatment had an overall positive effect on objective voice improvement, subjective voice improvement, and quality of live. Conclusion No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.
目的 肉毒杆菌毒素对痉挛性内收型发声障碍（AdSD）患者的疗效是暂时的。为优化长期治疗效果，应评估其他治疗选择。AdSD的替代治疗方案包括几种外科治疗，如甲状杓肌切开术、甲状成形术、选择性喉内收肌去神经再支配术、喉神经挤压术和喉返神经切除术。在此，我们首次进行系统评价，比较肉毒杆菌毒素与手术治疗对诊断为AdSD患者的疗效。 数据来源 MEDLINE（PubMed）、EMBASE和Cochrane图书馆。 方法 由2名独立作者对文章进行评审，并将数据整理成表格，用于分析客观结果（录音后语音专家评估）、主观结果（患者自我评估得分）和语音相关生活质量（语音健康指数得分）。 结果 未发现比较两种治疗方式的临床试验。单臂研究评估了肉毒杆菌毒素或手术治疗的效果。13项研究报告了肉毒杆菌毒素治疗后的结果（n = 419），9项研究报告了手术治疗后的结果（n = 585例患者）。发现双侧注射肉毒杆菌毒素对客观语音结果、主观语音结果和生活质量有积极影响。有益效果的持续时间为15至18周。手术治疗对客观语音改善、主观语音改善和生活质量总体有积极影响。 结论 无法证明对一种治疗方法有偏好。建议进行比较治疗方式的前瞻性临床试验，通过直接比较来确定最佳结果。
