UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA.
Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada.
Muscle Nerve. 2021 Apr;63(4):525-530. doi: 10.1002/mus.27161. Epub 2021 Jan 22.
Despite use of qualitative laryngeal electromyography (LEMG) guided botulinum toxin A (BoNT-A) injection for treatment of adductor spasmodic dysphonia (AdSD), unsatisfactory injections and complete "misses" remain problematic. We aimed to determine if the quantitative LEMG measure of number of small segments (NSS) correlates with voice outcomes following (BoNT-A injection for AdSD.
Automated quantitative LEMG analysis was performed during electromyography (EMG) -guided BoNT-A injection into the thyroarytenoid-lateral cricoarytenoid muscle complex for treatment of AdSD. Pre-injection phonatory NSS values were correlated with clinical voice outcomes and patient reported injection results.
Quantitative LEMG measures were obtained for 45 AdSD patients (28 female, mean age 60.8 ± 12.8 years) during EMG-guided BoNT-A injection. Mean sampled NSS during phonation immediately prior to BoNT-A injection was 524 ± 323 (range: 2-904). Mean follow up was 36.5 ± 9.4 days; one patient was lost to follow-up. In comparison to their previous BoNT-A injection, the current injection was rated as worse, same, and better by 13 (29.5%), 25 (56.8%), and 6 (13.6%) patients, respectively. All 4 (9.1%) patients with NSS < 200 rated their BoNT-A injection result as worse than previous, and change in Voice Handicap Index-10 (VHI-10) scores were worse or without change.
Aiming for an NSS value greater than 200 during phonation prior to BoNT-A toxin injection for AdSD may reduce unfavorable voice outcomes.
尽管使用定性喉肌电图（LEMG）引导肉毒毒素 A（BoNT-A）注射治疗内收肌痉挛性发音障碍（AdSD），但不满意的注射和完全“漏注”仍然是个问题。我们旨在确定在（BoNT-A 注射治疗 AdSD 之前，LEMG 的数量小片段（NSS）的定量测量是否与嗓音结果相关。
在肌电图（EMG）引导的 BoNT-A 注射到甲状软骨-环杓侧肌复合体中治疗 AdSD 期间，进行自动定量 LEMG 分析。在注射前的发音 NSS 值与临床嗓音结果和患者报告的注射结果进行相关性分析。
在 45 例 AdSD 患者（28 名女性，平均年龄 60.8 ± 12.8 岁）进行 EMG 引导的 BoNT-A 注射期间，获得了定量 LEMG 测量值。在 BoNT-A 注射前的发音期间，平均采样 NSS 为 524 ± 323（范围：2-904）。平均随访时间为 36.5 ± 9.4 天；1 例患者失访。与之前的 BoNT-A 注射相比，当前的注射分别被 13 例（29.5%）、25 例（56.8%）和 6 例（13.6%）患者评为更差、相同和更好。所有 4 例（9.1%）NSS<200 的患者都认为他们的 BoNT-A 注射结果比之前的更差，而且嗓音障碍指数-10（VHI-10）评分的变化更差或没有变化。
在 AdSD 之前的 BoNT-A 毒素注射前的发音期间，目标 NSS 值大于 200 可能会降低不良嗓音结果的发生。
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