Impact of an Upper Respiratory Tract Infection on Botulinum Toxin Efficacy in Spasmodic Dysphonia Patients.

Abstract

OBJECTIVE:

To determine whether the presence of a concomitant upper respiratory tract infection (URI) impacts upon Botulinum toxin (BoNT) efficacy in spasmodic dysphonia (SD) patients.

STUDY DESIGN:

Case series and literature review.

METHODS:

All SD patients with a concurrent URI, presenting for BoNT therapy at a clinical research center from November 2016 to December 2017 were included. A total of 12 patients were identified. Patients were followed for at least two BoNT treatment cycles (approximately 6 months). The primary outcome measure was efficacy of the initial BoNT injection and the secondary outcome measure was the efficacy of the subsequent BoNT injection.

RESULTS:

All subjects had adductor type SD (ADSD). There were 10 females and two males with a median age of 55 years (±19.5). All patients were well established on a consistent BoNT treatment regime, with an average administered dose of 1.0 unit (range 0.2-1.80 units). Bilateral injections were administered to 10 patients. Regarding the primary outcome measure, five failed to have any response to BoNT (41.7%), four had a partial response (33.3%), and three had a positive response to treatment (25.0%). When patients had their follow-up injection in the absence of URI symptoms, 11 patients had a positive response to treatment (91.7%).

CONCLUSION:

While the interplay between illness and BoNT efficacy is yet to be elucidated, we report that some patients are affected. We recommend that SD patients presenting for BoNT administration with a concomitant URI, should be counseled that their treatment might have decreased effect.

LEVEL OF EVIDENCE:

4 Laryngoscope, 130:1746-1749, 2020.

• Authors: Diana N Kirke, Rachel Kaye, Andrew Blitzer
• Journal: The Laryngoscope (Laryngoscope) Vol. 130 Issue 7 Pg. 1746-1749 (07 2020) ISSN: 1531-4995 [Electronic] United States
• PMID: 31508822 (Publication Type: Journal Article)
• Copyright: © 2019 The American Laryngological, Rhinological and Otological Society, Inc.

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Botulinum Toxins, Type A (administration & dosage)
• Dysphonia (complications, drug therapy)
• Female
• Follow-Up Studies
• Humans
• Injections, Intramuscular
• Laryngeal Muscles
• Male
• Middle Aged
• Neuromuscular Agents (administration & dosage)
• Respiratory Tract Infections (complications)
• Retrospective Studies
• Treatment Outcome