Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile.
Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile. Diagonal Paraguay 362, Otorrinolaringología, Santiago Centro, Santiago 8330077, Chile.
Auris Nasus Larynx. 2024 Feb;51(1):106-112. doi: 10.1016/j.anl.2023.06.004. Epub 2023 Jun 24.
Laryngeal dystonia (LD) is characterized by irregular and involuntary task-specific spasms of the intrinsic laryngeal muscles. There is no curative treatment for it, however, laryngeal botulinum neurotoxin injections (BoNT-I) are considered the standard of care therapy. This study aims to characterize the population of LD patients and to assess the results of laryngeal BoNT-I.
A Retrospective cohort study was conducted. Medical records were reviewed for all the patients with LD diagnosis seen in the Voice Unit of the Red de Salud UCChristus between January 2013 and October 2021. Biodemographic, clinical and treatment data were collected. Additionally, a telephonic survey was completed by the patients that underwent laryngeal BoNT-I, including self-reported voice outcomes and Voice Handicap Index 10 (VHI-10).
Of the 34 patients with LD included in the study, 23 received a total of 93 laryngeal BoNT-I and 19 completed the telephone survey. The majority (97%) of the injections corresponded to patients with adductor LD and 3% to abductor LD. Patients received a median of 3 (1-17) injections, with a more frequent cricothyroid approach (94.4%), while the thyrohyoid approach accounted for 5.6% of cases. Most injections were bilateral (96.8%). A significant improvement in the vocal quality and effort was noted after the last injection and the overall BoNT-I treatment (P < 0.001). Similarly, the VHI-10 score improved from a median of 31 (7-40) to 2 (0-19) (P < 0.001) after the last injection. A post-treatment breathy voice was reported in 95% of patients, and dysphagia to liquids and solids in 68% and 21%, respectively.
Laryngeal BoNT-I is an effective treatment for LD, achieving an improvement in self-reported vocal quality and VHI-10 scores, and a reduction of the self-reported vocal effort. Adverse effects are mild in the majority of cases, constituting a safe and effective therapy for these patients.
喉痉挛（LD）的特征是固有喉肌出现不规则且非自主的、与任务相关的痉挛。目前尚无有效的治疗方法，但喉部肉毒杆菌神经毒素注射（BoNT-I）被认为是标准的治疗方法。本研究旨在描述 LD 患者的人群特征，并评估喉部 BoNT-I 的治疗效果。
这是一项回顾性队列研究。我们对 2013 年 1 月至 2021 年 10 月期间在 Red de Salud UCChristus 的语音科就诊的所有 LD 患者的病历进行了回顾。收集了人口统计学、临床和治疗数据。此外，对接受过喉部 BoNT-I 的患者进行了电话调查，包括自我报告的声音结果和嗓音障碍指数 10 分（VHI-10）。
在纳入研究的 34 名 LD 患者中，23 名患者共接受了 93 次喉部 BoNT-I 注射，其中 19 名患者完成了电话调查。大多数（97%）注射用于治疗内收性 LD 患者，3%用于治疗外展性 LD 患者。患者接受了中位数为 3（1-17）次注射，更常采用环甲肌入路（94.4%），而甲状舌骨肌入路占 5.6%。大多数注射为双侧（96.8%）。末次注射和整个 BoNT-I 治疗后，患者的嗓音质量和发声费力均显著改善（P < 0.001）。同样，VHI-10 评分从末次注射前的中位数 31（7-40）分降至 2 分（0-19）分（P < 0.001）。95%的患者报告治疗后出现气息声，68%的患者出现液体吞咽困难，21%的患者出现固体吞咽困难。
喉部 BoNT-I 是治疗 LD 的有效方法，可改善自我报告的嗓音质量和 VHI-10 评分，并降低自我报告的发声费力程度。大多数情况下，不良反应较轻，是这些患者安全有效的治疗方法。
