title: Injection of botulinum toxin for the treatment of post-laryngectomy pharyngoesophageal spasm-related disorders.
abstract: Introduction Pharyngoesophageal spasm (PES) can cause dysphagia, central valve leak (CVL), and dypshonia in post-laryngectomy patients. Botulinum toxin has been used effectively for the treatment of PES, but data regarding patient-reported outcomes and efficacy for CVL are limited. We evaluated the results of botox injection for PES spasm using subjective and objective measures. Methods Data were collected prospectively (February 2010 to August 2013) on 13 patients undergoing botox injection for PES as identified by video fluoroscopy. We collected digital voice recordings, air-pressure measurements (APMs) for speech, and quality of life (QoL) data before and after the procedure: University of Washington QoL questionnaire (UW-QoL), MD Anderson Swallowing Inventory (MDADI) and the Voice Handicap Index (VHI-30). Results APMs for a sustained vowel decreased by 18% after botox injection, whereas maximum phonatory times increased by 63% (mean increase, 8 to 13 seconds). Sustained vowel amplitude decreased (mean, 87db to 83db) with an associated reduction in sustained vowel frequency (117Hz to 77Hz). MDADI scores improved by 10.2% overall, and UW-QoL scores showed an improvement in score of 7.6%. Mean scores for VHI-30 deteriorated by 2% overall but, when considering only those patients experiencing dysphonia, an improvement of 9.4% was seen. There was an overall net reduction for the CVL cohort of 12 speech valves in the year after injection. Conclusions Our series confirm the safety and objective efficacy of botox injection for PES. QoL measurements were less convincing, and this disparity between subjective and objective measurements must be considered when treating such patients.
authors.affiliation: Aintree University Hospitals NHS Foundation Trust.
authors.forename: K A
authors.initials: KA
authors.lastname: Lightbody
authors.affiliation: Aintree University Hospitals NHS Foundation Trust.|Liverpool Cancer Research Centre , UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Wilkie
authors.affiliation: Aintree University Hospitals NHS Foundation Trust.
authors.forename: A J
authors.initials: AJ
authors.lastname: Kinshuck
authors.affiliation: Aintree University Hospitals NHS Foundation Trust.
authors.forename: E
authors.initials: E
authors.lastname: Gilmartin
authors.affiliation: Aintree University Hospitals NHS Foundation Trust.
authors.forename: H
authors.initials: H
authors.lastname: Lewis-Jones
authors.affiliation: Aintree University Hospitals NHS Foundation Trust.|Liverpool Cancer Research Centre , UK.
authors.forename: T M
authors.initials: TM
authors.lastname: Jones
authors.affiliation: Aintree University Hospitals NHS Foundation Trust.
authors.forename: J
authors.initials: J
authors.lastname: Lancaster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D055154:Dysphonia / Q000188:drug therapy / Q000209:etiology; D004935:Esophageal Diseases / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D017060:Patient Satisfaction; D010608:Pharyngeal Diseases / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D011788:Quality of Life; D013035:Spasm / Q000188:drug therapy* / Q000209:etiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA
keywords: Botulinum toxin; Pharyngoesophageal hypertonicity; Pharyngoesophageal spasm