316 Botox Injections in Larynx as a Treatment for Vocal Cord Dysfunction

BACKGROUND: Vocal Cord Dysfunction (VCD) is a respiratory condition in which vocal cords restrict airflow by closing during inspiration. Symptoms include shortness of breath, coughing, chest tightness and wheezing. These symptoms are commonly reduced with breathing exercises to relax the chest and throat. VCD is often misdiagnosed as asthma and treated as such. Studies have shown that steroids used to treat asthma are not beneficial in the treatment of VCD, and are therefore unnecessary. Recent studies suggest that Botox injections to relax the thyroarythenoid muscles surrounding vocal cords resulting in an improvement in the patient's airflow. METHODS: We followed a 56-year-old female patient over the course of a year who had a history of upper espiratory infections, sinusitis, allergic rhinitis and asthma reporting an increase in the severity of respiratory symptoms even though successfully undergoing immunotherapy treatment and following a regimen of asthma medication. Her symptoms included shortness of breath, wheezing and trouble sleeping. RESULTS: Pulmonary function testing done elsewhere revealed that the patient had a reduced lung capacity. After a consult with a speech pathologist, VCD and Spastic Dysphonia (SD) were diagnosed. The symptoms where initially treated with speech therapy. Four months later the patient noted a slight improvement in her symptoms, but also attributed this to the fact that she had developed behavioral ways to cope with symptoms. The possibility of Botox injections was mentioned and the patient agreed to follow with this treatment. Two 2.5 unit injections of Botox were administered in the thyroarythenoid muscles via an EMG guided needle, without any complications. The results from the procedure were very favorable. All her symptoms improved significantly. Lung function tests appeared normal, and she was able to reduce the use of most asthma control medications. She received another dose of Botox injections 6 months following the first, and continues to do very well. CONCLUSIONS: Botox injections in the thyroarythenoid muscles are a successful treatment option for VCD patients with dysphonia. With this treatment patients are able to minimize respiratory symptoms and inhaled steroid use. A larger, randomized study with patients diagnosed with VCD alone should be considered.