Vocal fold botulinum toxin injection for refractory paradoxical vocal fold motion disorder.

Objective: Demonstrate efficacy of vocal fold botulinum toxin injection for treatment of refractory paradoxical vocal fold motion disorder (PVFMD).

Methods: A retrospective review was completed of patients diagnosed with PVFMD who underwent vocal fold botulinum toxin injection for dyspnea symptoms that persisted despite laryngeal control therapy, medical management, and biofeedback therapy. Outcomes measured included overall improvement and resolution of dyspnea symptoms, number of botulinum toxin injections and dose range, change in dyspnea severity index (DSI) scores, and adverse effects of injection therapy.

Results: Thirteen patients (9 female/4 male) underwent vocal fold botulinum toxin injection for refractory PVFMD. The average dose was 2.55 units per vocal fold (range 1.75-5.5 units). The average number of injections was 3.85 (range 1-12 injections). Eleven of 13 (84.6%) patients experienced improvement in dyspnea symptoms, with two of 11 (18.2%) having complete resolution of symptoms. There was a statistically significant improvement in DSI scores because the mean preinjection DSI was 30.43 and improved to 17.43 postinjection (P = 0.017). Temporary breathy voice quality was experienced by all patients with no other adverse side effects.

Conclusion: Vocal fold botulinum toxin injection is a safe and effective treatment option for PVFMD and should be considered in patients with refractory dyspnea symptoms following appropriate medical therapy and respiratory retraining protocols.

Level Of Evidence: 4 Laryngoscope, 129:808-811, 2019.