Comparison of the effects of esomeprazole plus mosapride citrate and botulinum toxin A on vocal process granuloma

Objectives

Vocal process granulomas have a high tendency for persistence despite many treatment alternatives. Anti-reflux medications or botulinum toxin A injections are the main current therapies. There are no studies that compare the effects on vocal process granuloma of proton pump inhibitors plus prokinetic agents with botulinum toxin A injections.

Increased stability of airflow following botulinum toxin injection.

OBJECTIVES: The purpose of this study was to determine whether stability of airflow, as well as mean airflow, increased following botulinum toxin injection to laryngeal and extralaryngeal muscles in persons with spasmodic dysphonia (SD), some with associated vocal tremor (VT). STUDY DESIGN: Aerodynamic data were collected from five subjects before and at 2, 4, and 8 weeks after they received treatment by each of two different arms in an injection protocol in a crossover study. One arm of the protocol involved treatment of the thyroarytenoid muscles only. The other arm involved treatment of both the thyroarytenoid muscles and the strap muscles. METHODS: Measures of mean airflow and coefficient of variation (COV) of airflow during phonation were obtained. A decrease in the COV of airflow would indicate increased stability of phonatory airflow. RESULTS: Before treatment, all subjects with SD/VT exhibited mean airflows that were similar to controls. The COV of airflow ranged from normal to substantially elevated. Following botulinum injection, mean airflow characteristically increased and COV of airflow decreased. CONCLUSIONS: This finding suggests there is a change in the type, as well as the level, of activity in the muscles of speech production following botulinum toxin injection. The increase in airflow stability identified could be due to increased stability of the laryngeal system and possibly of the respiratory system as well.     

硫酸锌治疗声带突肉芽肿的疗效分析

目的探讨硫酸锌治疗声带突肉芽肿的疗效。方法2007-2012年对15例声带突肉芽肿患者给予饭后服用硫酸锌口服液100 ml（含硫酸锌200 mg）,3次/d,服药直至声带突肉芽肿消失。此后每月复查电子喉镜,3个月后每3个月定期复查,随访1年。根据喉部声带突肉芽肿的标准对患者进行分类,对比治疗前后图像,观察疗效。结果12例1个月内肉芽肿消失;3例1个月内肉芽肿缩小,其中2例2个月内消失,1例3个月内消失。治疗后所有患者声嘶、咽痛、咽异物感、咳嗽不适等症状均有明显改善。15例随访1年未见复发及并发症。结论硫酸锌是治疗声带突肉芽肿的一种安全有效的方法,尤其对手术后复发者疗效显著,不失为一种有效的治疗及补救措施。     

Periodic botulinum toxin injections for paradoxical vocal fold motion in a child with cerebral palsy: A case study

We describe an unusual case of paradoxical vocal fold motion in a child with cerebral palsy. Clinically, the child presented with mild stridor, which worsened over months, eventually requiring emergency intubation. After an unsuccessful trial of medical management, microlaryngoscopy revealed abnormal adduction of the vocal folds during inspiration. This was successfully treated with periodic type A botulinum toxin injections to the vocal folds, sparing the child from tracheostomy.     

Thyroarytenoid botulinum toxin injection for refractory laryngeal contact granuloma

BackgroundAlthough there are many treatments for laryngeal contact granuloma (LCG), some patients still fail treatment. Botulinum toxin A injection vocal cords may be a salvage therapy.ObjectivesTo study the efficacy of thyroarytenoid botulinum toxin A injection for the treatment of refractory LCG.Material and methodsFrom May 2021 to March 2022, 23 male patients with refractory idiopathic LCG were treated by injection of botulinum toxin A into the thyroarytenoid muscle via the thyrohyoid membrane approach. Inspiratory-phase laryngoscopy images were collected before treatment and 3 months after injection treatment. The lesion size was evaluated with the Farwell granuloma endoscopic grading system and Image J software.ResultsThe average age of 23 patients was 49 years. The dose of botulinum toxin injection ranged from 2.5 to 5 units. Three months after injection, 17 patients were cured, 2 patients showed marked improvement, and 4 patients did not experience any effect. The total efficacy rate was 82.61% (19/23), and no serious complications occurred. Almost all patients experienced hoarseness within one week after injection; they gradually recovered after one month, and their voice returned to baseline at 3 months.ConclusionsThyroarytenoid botulinum toxin injection is an effective method for resolving refractory LCG.     

Ear wiggling tics: treatment with botulinum toxin injection

Ear wiggling tics are a rare disorder and there is no reported satisfactory treatment. We had a patient present with ear wiggling tics, which we treated with injections (totaling 40 units) of botulinum toxin A to the pinna muscle (i.e., the auricularis anterior and superior). The tics completely disappeared within 9 days of injection without any side effects.     

Treatment of vocal fold granuloma using botulinum toxin type A

Contact granuloma of the vocal folds has been associated with abnormal use of the voice, and acid reflux may exacerbate the inflammatory process. Treatments have included voice therapy and antireflux measures. Surgical excision is considered in patients who do not respond to medical management. Localized injections of botulinum toxin type A (BOTOX®) have been effective in patients with disorders of muscular control in the head and neck. In this study, granulomas resolved in six patients who underwent injection of the affected vocal folds. Botulinum toxin type A is probably successful because it prevents forceful closure of the arytenoids during phonation and coughing. Localized injection of this neurotoxin is promising both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates.     

A 型肉毒毒素治疗半面痉挛及眼睑痉挛

目的观察Ａ型肉毒毒素治疗半面痉挛及眼睑痉挛的效果。方法Ａ型肉毒毒素局部注射（每点２．５～５Ｕ）治疗眼睑痉挛１２例（１５侧）及半面痉挛３８例。结果完全缓解分别为１０例（１３侧，占８６．７％）及３２例（８４．２％），明显缓解分别为２例（１３．３％）及５例（１３．２％），部分缓解分别为０例及１例（２．６％）。总有效率１００％。药效作用时间分别为１０～２４周（平均１８周）及１４～３２周（平均２２周）。局部副反应轻微、短暂，包括轻度面瘫８例、眼睑下垂４例、流泪４例，无全身反应及过敏反应。结论Ａ型肉毒毒素局部注射是治疗眼睑痉挛及半面痉挛的一种安全、有效、简便方法。     

CO2激光杓状软骨声带突切除与肌腱切断治疗双侧声带外展麻痹

目的：探讨CO2激光杓状软骨声带突切除与肌腱切断治疗双侧声带外展麻痹的应用价值。方法：回顾性分析18例因甲状腺切除术后双侧声带外展麻痹的临床资料,术前预防性气管切开后,行CO2激光杓状软骨声带突切除与肌腱切断术。结果：18例患者术后即可经口鼻呼吸,其中15例于术后8周内拔管;3例于术后4～6周因局部肉芽组织增生再次激光手术后拔管;所有患者随访1．6～2．3年,无呼吸困难及误吸,对发声满意。结论：CO2激光杓状软骨声带突切除与肌腱切断,可有效改善双侧声带外展麻痹造成的呼吸困难,并取得较满意的发声,以及避免误吸。     

重复局部注射A型肉毒毒素治疗眼睑及面肌痉挛的疗效观察

目的:观察重复局部注射A型肉毒毒素(BTXA)治疗眼睑及面肌痉挛的长期疗效。方法:对80例眼睑、面肌痉挛的患者(眼睑痉挛75侧,面肌痉挛65侧),连续重复局部注射BTXA 4~20次,共886次,面肌痉挛每次剂量为22.5~32.5 U,眼睑痉挛为12.5~15.0 U。随访2~8年,观察其长期疗效。结果:起效时间多于治疗后2~3 d。眼睑及面肌痉挛治疗后部分缓解、明显缓解、完全缓解分别为0、67.7%、32.7%及1.4%、72.3%、26.3%,总有效率100%。随注射次数增加,药物剂量未增加,药效持续时间分别为(19.9±4.5)周及(20.7±4.2)周(P>0.05)。局部不良反应轻微、短暂。结论:重复局部注射BTXA治疗面肌及眼睑痉挛,在不需增加剂量的情况下,可长期维持其疗效和作用持续时间,而且是一种安全、有效和简便的治疗方法。     

Effects of botulinum toxin on vocal tract steadiness in patients with spasmodic dysphonia

Since laryngeal botulinum toxin (BTX) injections have become the treatment of choice for spasmodic dysphonia, the purpose of this study was to examine its effects on the stability of the upper vocal tract as compared to the effects on glottic stability. Two different acoustic methods were used to analyze voice samples from 16 patients with adductor-type spasmodic dysphonias before and after BTX therapy and from a normal control group. Independent acoustic analyses were used to determine laryngeal and upper vocal tract stability. The results showed significantly higher values for the standard deviation of fundamental frequency (SDFO), reflecting laryngeal instability, for the patient group than for the control group and an impressive improvement for the patients after BTX therapy. Further, the equally high values of SDFO for the initial second and a second from the midsegment of phonation were differentially reduced by BTX therapy, resulting in a normal pattern of laryngeal stability during sustained phonation. The variability of the first and second formants, reflecting upper vocal tract instability, showed higher values for the patients compared with the control group, but this difference was not statistically significant. The present findings showed that BTX injections to the thyroarytenoid muscle had no discernible effect on stability of the upper vocal tract.Presented in part at the 65th Annual Meeting of the German Society of Oto-Rhino-Laryngology-Head and Neck Surgery, Chemnitz, 14–18 May 1994 and the First World Voice Congress in Oporto, Portugal, 9–13 April 1995     

The effects of one botulinum toxin type A (BTX-A) injection after UPPP

Botulinum toxin type A (BTX-A) can be used in various medical fields for more than simply cosmetic purposes, especially in pain control. Unlabelled uses of BTX-A for reducing pain include migraines, chronic anal fissures, chronic non-specific muscular pain syndrome, and temporomandibular joint arthritis. However, there are no reports of using BTX-A in postoperative situation. Therefore, we evaluated the effects of BTX-A after surgical procedures, especially in terms of pain reduction. We randomly selected 74 people who visited us not excluded by the criteria and were provided with uvulopharyngopalatoplasty for primary snoring from February 2005 to January 2007. Group A is the BTX-A-injected group and group B is the control group (normal saline injected group or N/S). Group A had 35 patients and group B had 39 patients. Among these patients, we chose 58 patients who can be under tracing observation. The mean age was 26 years (range 18-41). There were 49 males and 9 females. We compared the level of snoring, postoperative pain, use of drugs, and postoperative foreign body sensation with survey paper. Snoring scores were dramatically decreased in both the groups. Postoperative pain scores and foreign body sensation scores were much more decreased in group A than in group B (P < 0.001) and the total amount of NSAIDs used were lower in group A (P < 0.001). BTX-A could be used to reduce postoperative pain after snoring surgery by reducing a specific complication.     

The use of botulinum toxin for pediatric cricopharyngeal achalasia

Objectives

Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia.

Methods

A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, post-operative need for nasogastric tube placement, and swallow studies.

Results

A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed.

Conclusions

Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy.     

The use of botulinum toxin for pediatric cricopharyngeal achalasia

Objectives

Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia.

Methods

A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, post-operative need for nasogastric tube placement, and swallow studies.

Results

A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed.

Conclusions

Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy.     

The value of local botulinum toxin A injection in the treatment of the pain of aphthous ulcer

To determine the effectiveness of botulinum toxin type A to reduce pain of recurrent aphthous ulcer, a single blinded placebo controlled trial of botulinum toxin A injection was performed. A total of 70 patients were enrolled and randomly received a botulinum toxin type A 1 unit or placebo. The patients were asked to note the level of pain on the visual analogue scale for 6 days. They also had to record any eventual side effects or recurrence for 6 months. More patients quickly recovered following Botulinum toxin type A injection than placebo; they would feel almost no pain after about 3 days. Botulinum toxin type A exhibits quick pain treatment effect following injection on aphthous ulcer. The author also believes that it can prevent recurrence for at least 6 months after injection.     

Potassium titanyl phosphate laser treatment of intubation vocal granuloma

Vocal process granuloma is an uncommon occurrence which is possibly related to endotrachial intubation. Despite its infrequent occurrence, intubation vocal granuloma has received considerable attention in the literature on account of its versatile clinical managements and various results. We presented a series of cases afflicted with intubation vocal granuloma and documented the promising effect of potassium titanyl phosphate (KTP) laser ablation. Twelve patients of intubation vocal granuloma had been retrospectively reviewed at Tri-Service General Hospital from January 1999 to June 2006. Detailed history taking, physical examination, and voice analysis were conducted in all patients before and after this surgical intervention. They all underwent KTP laser ablation of vocal granuloma. Patients were 7 females and 5 males with a mean age of 46.8 years. The grade of hoarseness, roughness, breathiness, asthenia, and strain (GRBAS) scale and maximum phonation time (MPT) showed significant different before and after this surgical intervention (P < 0.05). There was no recurrence in all patients for at least 14 months in the follow-up. We have found that KTP laser microlaryngosurgery can be a useful therapy and can lead avoidance of repetitive surgical procedures.     

Volume analysis of preadipocyte injection for vocal cord medialization

OBJECTIVE: To compare the volume retention of injected preadipocytes with that of standard fat injection in a paralyzed rabbit true vocal cord. STUDY DESIGN: Prospective analysis with blinded data collection. METHODS: Thirteen New Zealand white rabbits were divided into two groups. Group 1 consisted of seven animals undergoing left-side vocal cord paralysis by resection of a 1-cm segment of the left-side recurrent laryngeal nerve and abdominal fat harvest for isolation of preadipocytes. Preadipocytes were cultured under sterile conditions in cell culture media. Animals in group 2 also underwent left-side vocal cord paralysis without fat harvest. After 10 to 14 days, in a second procedure, group 1 underwent injection of 0.1 mL cultured autologous preadipocytes, and group 2 underwent routine injection of 0.1 mL abdominal fat harvested during the same procedure. At 6 and 12 months, volumetric analysis was performed. RESULTS: Volume analysis at 6 months showed a mean volume of 0.029 mL retained fat in group 2 representing a retention of approximately 29% (SD = 0.023) of the original injected volume. Retention in group 1 animals approximated 0.002 mL (SD = 0.0024) or 2% of the injected volume. Analysis at 12 months showed a mean volume of 0.008 mL (SD = 0.0078) in group 2 and of 0.002 mL (SD = 0.0015) in group 1. Group 2 showed significantly higher volumes of the injected fat at 6 and 12 months (P <.033). CONCLUSION: Volumes obtained with standard fat injection were superior to those obtained with preadipocyte injection at both 6 and 12 months.     

Idiopathic ulcerative laryngitis causing midmembranous vocal fold granuloma

Idiopathic ulcerative laryngitis (IUL) is characterized by bilateral midmembranous vocal fold ulceration, which follows upper respiratory infection with cough. In contrast, granuloma of the membranous vocal fold can occur rarely following microlaryngoscopy, presumably secondary to surgical violation of deep tissue planes. We report a novel case of noniatrogenic membranous vocal fold granulation developing in a patient with IUL. Although the presence of granulation implied injury to the entire microstructure of the vibratory portion of the vocal fold, the lesion resolved with conservative management without adverse sequelae.     

喉接触性肉芽肿临床分析及治疗方法探讨

目的：探讨喉接触性肉芽肿的临床特点及治疗方法。方法：回顾性分析我科2005-01-2012—12期间13例有完整资料的喉接触性肉芽肿的发病特点、相关病因、临床表现及治疗方法,比较保守治疗及手术治疗疗效并探讨其治疗方法选择。结果：喉接触性肉芽肿好发于男性（84．6％）,其相关病因以胃食管返流病、慢性咳嗽及习惯性清嗓病史、气管插管病史多见,无明显病因亦占重要比例（38．4％）。临床表现以喉异物感、说话易疲劳、声嘶多见,无任何喉部症状占30．7％。手术治疗6例,初次复发率为66．6％,1次及2次手术后有效率为50．0％。保守治疗7例,抗胃食管返流、避免过度用嗓、减少习惯性清嗓动作以及未予药物治疗,有效率为57．1％。2组总有效率为53．8％,2组间疗效比较差异无统计学意义。结论：目前喉接触性肉芽肿治疗疗效较差,治疗方案尚无统一标准,应采取个体化治疗。首选针对病因保守治疗,对于有明显声音嘶哑或肉芽肿过大影响呼吸者可考虑手术治疗。