Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis

Mustafa Sahin; Ibrahim Aydogdu; Serdar Akyildiz; Munevver Erdinc; Kerem Ozturk; Fatih Ogut

doi:http://dx.doi.org/10.21053/ceo.2016.00241

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자료유형: 학술저널

저자정보: Mustafa Sahin (Adnan Menderes University) Ibrahim Aydogdu (Ege University Medical School) Serdar Akyildiz (Ege University Medical School) Munevver Erdinc (Ege University Medical School) Kerem Ozturk (Ege University Medical School) Fatih Ogut (Ege University Medical School)

저널정보: 대한이비인후과학회 Clinical and Experimental Otorhinolaryngology Clinical and Experimental Otorhinolaryngology 제10권 제2호

발행연도: 2017.6

수록면: 193 - 202 (10page)

DOI: http://dx.doi.org/10.21053/ceo.2016.00241

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Objectives. Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection. Methods. Before and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used. Results. All patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values. Conclusion. After BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.

#Bilateral Vocal Fold Paralysis #Botulinum Toxin #Cricothyroid Muscle

참고문헌 (26)

참고문헌 신청

Zealear DL / 2004 / Neurophysiology of vocal fold paralysis / Otolaryngol Clin North Am 37(1):1~23

Myssiorek D. / 2004 / Recurrent laryngeal nerve paralysis: anatomy and etiology / Otolaryngol Clin North Am 37(1):25~44

Misiolek M / 2001 / Recurrent laryngeal nerve palsy after thyroid cancer surgery: a laryngological and surgical problem / Eur Arch Otorhinolaryngol 258(9):460~462

Hillel AD / 1999 / Evaluation and management of bilateral vocal cord immobility / Otolaryngol Head Neck Surg 121(6):760~765

Dursun G / 2006 / Aerodynamic, acoustic and functional results of posterior transverse laser cordotomy for bilateral abductor vocal fold paralysis / J Laryngol Otol 120(4):282~288

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