NEW YORK (Reuters Health) – Both adductor spasmodic dysphonia (ADSD) and vocal or laryngeal tremor (LT) can be treated effectively with botulinum toxin, researchers say.
“The longstanding belief that LT is not responsive to Botox should be dispelled,” Dr. David Francis of the University of Wisconsin in Madison said in an email to Reuters Health. “Patients with isolated lateral LT can be treated very similarly to those with ADSD, with comparable outcomes if patients are carefully selected.”
“Those with mixed LT will not respond as well as those with isolated LT,” he added.
Dr. Francis and colleagues retrospectively analyzed Vanderbilt Voice Center data from patients treated with botulinum toxin A injections for ADSD, ADSD+LT, and lateral LT without ADSD from 1990 to 2016.
Diary data were used to evaluate patient-perceived effectiveness of the injections – specifically, the number of patient-reported good voice days (voice breaks or tremor minimized to patient satisfaction) and the percentage of injections associated with achieving maximal voice quality (significant or complete reduction in vocal tremor or spasms during a treatment cycle).
As reported online February 8 in JAMA Otolaryngology-Head and Neck Surgery, 548 patients (mean age, 57; 81% women) who underwent 12,771 injection sessions met the inclusion criteria: 328 were diagnosed with ADSD, 77 with ADSD+LT, and 143 with lateral LT without ADSD.
A preliminary analysis found a greater mean number of good voice days after a botulinum A injection in patients with lateral LT compared with mixed tremor (MT), with a mean difference of 11.3 days (72.7 vs. 61.4); the mean percentage of maximally beneficial injections achieved over the treatment course was higher for lateral LT (65.5%) than for the MT group (57.7%). Subsequent analyses included lateral LT but excluded MT.
Overall, after adjustment, the mean number of good voice days was 81.1 for patients with ADSD, 75.4 for those with ADSD+LT, and 71.3 for those with lateral LT without ADSD.
The mean percentage of maximally beneficial injections over the treatment course was 88.1% for ADSD, 83.4% for ADSD+LT, and 70.4% for LT without ADSD.
Dr. Francis said, “Our findings should help physicians to better counsel patients and manage expectations about effectiveness.”
Dr. Joseph Spiegel, co-director, Jefferson Voice and Swallowing Center at Thomas Jefferson University in Philadelphia commented, “This article is an important and well-documented review of a large patient population with these disorders.”
“The diagnosis of spasmodic dysphonia can be difficult and the differential diagnosis with laryngeal tremor especially challenging,” he told Reuters Health by email. “This study provided new information to help in more accurate diagnosis in laryngeal tremor to direct improved treatment outcomes.”
“The outcomes presented are similar to those observed at our center,” he noted. “The biggest caveat of treatment is accurate diagnosis.”
“Spasmodic dysphonia is not a common condition, so clinicians should direct patients to individual otolaryngologists or centers with specific experience in treating these patients,” he stressed.
“Laryngologists, subspecialists in voice disorders within the field of otolaryngology are best equipped to evaluate and treat this condition,” Dr. Spiegel concluded. “Surgery is also available but is usually not a primary treatment option (and) is usually reserved for patients who cannot receive laryngeal Botox injection due to intolerance, complicating medical conditions or logistical barriers.”
SOURCE: http://bit.ly/2EnXJre
JAMA Otolaryngol Head Neck Surg 2018.
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