Videostroboscopy of the pharyngoesophageal segment in laryngectomy patients treated with botulinum toxin.
OBJECTIVE
The purpose of this investigation was to use videostroboscopy to study the physiologic and biomechanical effects of botulinum toxin (Botox) injection on the pharyngoesophageal segment (PES) in total laryngectomy patients with poor-quality tracheoesophageal puncture (TEP) voice caused by PES spasm.


METHODS
The following was a prospective study. Videostroboscopy of the PES and videotaped recordings of patients performing TEP voice tasks were conducted before and after Botox injection of the PES. Ratings of videostroboscopic and speech samples were performed by 3 blinded judges with extensive experience with this patient population.


RESULTS
Perceptually, TEP voice was more fluent and less strained after injection. Videostroboscopically, patients demonstrated improved PES volitional control and mucosal wave characteristics after Botox injection.


CONCLUSIONS
Botox injection in total laryngectomy patients with poor-quality TEP voice caused by PES spasm provides improved physiologic and biomechanical function of the PES, as demonstrated for the first time videostroboscopically. These findings help explain the perceptual ratings of TEP voice improvement noted after Botox injection. Videostroboscopy can be used to provide diagnostic information to help confirm the clinical impression of PES spasm, as well as to document the effects of Botox injection on PES function.
Meleca
R J
RJ
Department of Otolaryngology-Head and Neck Surgery, Wayne State University, School of Medicine, USA.
Dworkin
J P
JP
Zormeier
M M
MM
Simpson
M L
ML
Shibuya
T
T
Mathog
R H
RH
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004947:Esophagus / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007825:Laryngectomy; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000187:drug effects* / Q000503:physiopathology; D013065:Speech Intelligibility / Q000187:drug effects; D013068:Speech Production Measurement; D013072:Speech, Esophageal; D014741:Video Recording
D019274:Botulinum Toxins, Type A