title: Botulinum toxin treatment of false vocal folds in adductor spasmodic dysphonia: Functional outcomes.
abstract: OBJECTIVE
  Supraglottic injection of botulinum toxin (Botox) has been described as an effective treatment for adductor spasmodic dysphonia (ADSD). Anecdotal evidence suggests that the patients have little to no breathiness after injection, but no formal longitudinal studies have been carried out to date. The purpose of this study was to examine the voice outcomes in patients with ADSD after supraglottic Botox injection.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Patients with ADSD who were treated with supraglottic Botox injections completed a qualitative self-evaluation of voice function after injection using the percentage of normal function (PNF) scale, a validated, quantitative scale from 0% (no function) to 100% (normal function). Posttreatment voice improvement after injection was determined using a Voice Handicap Index-10 (VHI-10) questionnaire.
  
  
  RESULTS
  A total of 198 supraglottic injections were performed between July 2011 and October 2014. Twenty-five questionnaires were completed. Mean postinjection PNF was 95.0% ± 8.4% and was significantly increased from the preinjection mean PNF (62.5%) ± 22.6% (P < 0.001). The mean best VHI-10 for all injections was 7.23. In 19 of 25 patients (76%), there was no reduction in PNF in the early postinjection period. In the remaining six patients (24%), the decline in mean vocal function was 9.2%.
  
  
  CONCLUSIONS
  Supraglottic Botox injection is an effective treatment for ADSD. Postinjection voice is significantly improved, and the majority of patients do not experience breathy voice/decline in vocal function after injection.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, U.S.A.
authors.forename: C Blake
authors.initials: CB
authors.lastname: Simpson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, U.S.A.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia, U.S.A.
authors.forename: Jeanne L
authors.initials: JL
authors.lastname: Hatcher
authors.affiliation: Department of Epidemiology and Biostatistics, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, U.S.A.
authors.forename: Joel
authors.initials: J
authors.lastname: Michalek
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D055154:Dysphonia / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007821:Laryngeal Muscles / Q000187:drug effects* / Q000294:innervation; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014827:Vocal Cords / Q000187:drug effects*; D014833:Voice Quality
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Adductor spasmodic dysphonia; Botox; botulinum toxin; false vocal folds; longitudinal functional outcomes; supraglottic