Outcomes Assessment following Treatment of Spasmodic Dysphonia with Botulinum Toxin

Abstract

Spasmodic dysphonia (SD), a disabling focal dystonia involving the laryngeal musculature, is most commonly treated by the intramuscular injection of botulinum toxin (BTX). Although the treatment is well tolerated and generally produces clinical voice improvement, it has never been statistically shown to alter the patient's perception of voice quality or general health. Declining resources for medical care mandate that treatment outcomes be documented. A prospective analysis of the effects of BTX on the patient's perception of voice and general health was undertaken. The Voice Handicap Index (VHI) and Short Form 36 (SF-36) surveys were administered to patients before treatment and 1 month after. Pretreatment and posttreatment scores were analyzed with a Student's t-test. On the VHI, improvements in the patients' perception of their functional, physical, and emotional voice handicap reached statistical significance (p ≤ .0005). On the SF-36, patients had statistically significant improvements in mental health (p ≤ .03) and social functioning (p ≤ .04). Treatment of SD with BTX significantly lessened the patients' perception of dysphonia. In addition, it improved their social functioning and their perception of their mental health. These outcome measures justify the continued treatment of SD with BTX.

Keywords

abductor adductor botulinum toxin dystonia spasmodic dysphonia Voice Handicap Index

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References

Nutt

Muenter

Aronson

Kurland

Melton

III . Epidemiology of focal and generalized dystonia in Rochester, MN. Mov Disord 1988; 3: 188–94.

Blitzer

Brin

Fahn

Lovelace

. Clinical and laboratory characteristics of focal laryngeal dystonia: Study of 110 cases. Laryngoscope 1988; 98: 636–40.

Coffield

Considine

Simpson

. The site and mechanism of action of botulinum neurotoxin. In: Jankovic

Hallett

, eds. Therapy with botulinum toxin. New York, NY: Marcel Dekker, 1994: 3–13.

Blitzer

Brin

. Spasmodic dysphonia evaluation and management. In: Fried

, ed. The larynx: a multidisciplinary approach. 2nd ed. St Louis, Mo: Mosby-Year Book, 1996: 187–98.

Dedo

Izdebski

. Intermediate results of 306 recurrent laryngeal nerve sections for spastic dysphonia. Laryngoscope 1983; 93: 9–16.

Weed

Jewett

Rainey

. Long-term follow-up of recurrent laryngeal nerve avulsion for the treatment of spastic dysphonia. Ann Otol Rhinol Laryngol 1996; 105: 592–601.

Ludlow

Rhew

Nash

. Botulinum toxin injection for adductor spasmodic dysphonia. In: Jankovic

Hallett

, eds. Therapy with botulinum toxin. New York, NY: Marcel Dekker, 1994: 437–50.

Schantz

. Historical perspective. In: Jankovic

Hallett

, eds. Therapy with botulinum toxin. New York, NY: Marcel Dekker, 1994: xxii–xxvi.

Ware

Snow

Kosuski

Gandek

. SF-36 Health Survey manual & interpretation guide. Boston, Mass: The Health Institute, NEMC, 1993.

10.

Jacobson

Johnson

Grywalski

. The Voice Handicap Index (VHI): Development and validation. Am J Speech Lang Pathol 1997; 6(3): 66–70.

11.

Koriwchak

Netterville

Snowden

Courey

Ossoff

. Alternating unilateral botulinum toxin type A (Botox) injections for spasmodic dysphonia. Laryngoscope 1996; 106: 1476–81.