title: Safety of simultaneous bilateral botulinum toxin injections for abductor spasmodic dysphonia.
abstract: OBJECTIVE
  To review the safety of simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections.
  
  
  METHODS
  Retrospective case series review.
  
  
  METHODS
  Tertiary care academic clinic.
  
  
  METHODS
  Twenty-one patients with abductor spasmodic dysphonia.
  
  
  METHODS
  Patients received 100 simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections for isolated abductor spasmodic dysphonia over a 6-year period.
  
  
  METHODS
  Major and minor complications, injection dosing, and demographics.
  
  
  RESULTS
  The total bilateral botulinum toxin injection dose per session ranged from 2.50 to 7.50 U, and the average total bilateral dose per patient was 4.70 U. There were no major complications, and minor complications were self-limited. There was a 5% incidence of significant dyspnea and a 2% incidence of dysphagia, and all patients were treated conservatively. The average doses at which dyspnea and dysphagia occurred were 4.97 and 5.56 U, respectively.
  
  
  CONCLUSIONS
  This case series demonstrates that simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injection is safe up to the highest doses reported. Complications with this approach are consistent with those previously reported using other methods. Prospective studies on vocal outcome measures are needed for simultaneous bilateral posterior cricoarytenoid muscle botulinum toxin injections to evaluate the efficacy of this technique.
authors.affiliation: Department of Otolaryngology, Emory University, Atlanta, Ga., USA.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Stong
authors.forename: John M
authors.initials: JM
authors.lastname: DelGaudio
authors.forename: Edie R
authors.initials: ER
authors.lastname: Hapner
authors.forename: Michael M
authors.initials: MM
authors.lastname: Johns
mesh_terms: D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007821:Laryngeal Muscles / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014827:Vocal Cords / Q000187:drug effects*; D014832:Voice Disorders / Q000188:drug therapy*
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins