title: Botulinum toxin injections for new onset bilateral vocal fold motion impairment in adults.
abstract: OBJECTIVE
  Review of clinical experience and results using botulinum toxin type A (BTX) for the management of adult patients with respiratory compromise due to new onset bilateral vocal fold motion impairment (BVFMI).
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  The records of 11 patients from two institutions with respiratory compromise due to bilateral vocal fold motion impairment were reviewed. Age, sex, etiology of motion impairment, subjective response to BTX injections, changes in pulmonary function studies pre- and postinjection when available, the dosage of botulinum toxin required to achieve response, the number of injections per patient, and complications were reported.
  
  
  RESULTS
  All patients were over 18 years old. There were three male and eight female subjects. The etiology of BVFMI was due to previous anterior cervical surgery in nine patients and prolonged intubation in two. Ten patients reported symptomatic improvement and returned for an average of nine injections over the 10-year period of study. The most common interval between injections was 3 months. In all patients the dose required to achieve symptomatic improvement was at least 2.5 mouse units injected into each vocal fold. One patient without relief of symptoms had bilateral cricoarytenoid joint fixation. Complications were limited to moderate dysphagia in one patient and breathy dysphonia in all patients.
  
  
  CONCLUSIONS
  BTX injection into the vocal folds provides temporary relief of symptoms in airway obstruction in adult patients with BVFMI. Patients require an average of 2.5 units of botulinum injection into each vocal fold and have an average length of response of 3 months. BTX injection may be used as a form of temporary relief of airway obstruction in patients wishing to avoid ablative surgery or tracheotomy.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Rochester, Minnesota, USA.
authors.forename: Dale C
authors.initials: DC
authors.lastname: Ekbom
authors.forename: C Gaelyn
authors.initials: CG
authors.lastname: Garrett
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Yung
authors.forename: Felicia L
authors.initials: FL
authors.lastname: Johnson
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Billante
authors.forename: David L
authors.initials: DL
authors.lastname: Zealear
authors.forename: Mark S
authors.initials: MS
authors.lastname: Courey
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D014827:Vocal Cords; D014833:Voice Quality
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A