scholarly journals Ultrasonography-guided botulinum toxin injection to the cricopharyngeus muscle: a case report and technical notes

2020 ◽  
Vol 22 (3) ◽  
pp. 345 ◽  
Author(s):  
Yi-Chian Wang ◽  
Chueh-Hung Wu ◽  
Shaw-Gang Shyu ◽  
Ming-Yen Hsiao ◽  
Tyng-Guey Wang
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Food Passage ◽  
Cricopharyngeus Muscle ◽  
Lateral Medullary Syndrome ◽  
Pressure Region ◽  
Effective Choice ◽  
High Pressure Region ◽  
Common Target

Dysphagia associated with the cricopharyngeus muscle (CPm) dysfunction negatively influences the quality of life. This high-pressure region must relax and the lumen must open for smooth food passage. The CP muscle is therefore a common target of chemodenervation with botulinum toxin (BTX). Here we presented a patient with severe left lateral medullary syndrome and non-relaxation of the CPm. We described how to localize the CPm in the transverse and longitudinal views under ultrasonography and offered a video demonstrating ultrasonography-guided BTX injection. Ultrasonography-guided CPm injection with BTX may serve as a reliable, rapid, and effective choice for treatment of cricopharyngeal dysphagia.

scholarly journals Quality Assessment of Online Patient Information for Cosmetic Botulinum Toxin

2020 ◽  
Vol 40 (11) ◽  
pp. NP636-NP642 ◽  
Author(s):  
Eric Barbarite ◽  
David Shaye ◽  
Samuel Oyer ◽  
Linda N Lee
Keyword(s):  
Botulinum Toxin ◽  
Patient Education ◽  
Online Education ◽  
Grade Level ◽  
Assessment Tool ◽  
Botulinum Toxin Injection ◽  
Reading Level ◽  
Accuracy Score ◽  
Flesch Reading Ease

Abstract Background In an era of widespread Internet access, patients increasingly look online for health information. Given the frequency with which cosmetic botulinum toxin injection is performed, there is a need to provide patients with high-quality information about this procedure. Objectives The aim of this study was to examine the quality of printed online education materials (POEMs) about cosmetic botulinum toxin. Methods An Internet search was performed to identify 32 websites of various authorship types. Materials were evaluated for accuracy and inclusion of key content points. Readability was measured by Flesch Reading Ease and Flesch-Kincaid Grade Level. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Printed Materials. The effect of authorship was measured by undertaking analysis of variance between groups. Results The mean [standard deviation] accuracy score among all POEMs was 4.2 [0.7], which represents an accuracy of 76% to 99%. Mean comprehensiveness was 47.0% [16.4%]. Mean Flesch-Kincaid Grade Level and Flesch Reading Ease scores were 10.7 [2.1] and 47.9 [10.0], respectively. Mean understandability and actionability were 62.8% [18.8%] and 36.2% [26.5%], respectively. There were no significant differences between accuracy (P > 0.2), comprehensiveness (P > 0.5), readability (P > 0.1), understandability (P > 0.3), or actionability (P > 0.2) by authorship. Conclusions There is wide variability in the quality of cosmetic botulinum toxin POEMs regardless of authorship type. The majority of materials are written above the recommended reading level and fail to include important content points. It is critical that providers take an active role in the evaluation and endorsement of online patient education materials.

Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial

2010 ◽  
Vol 119 (11) ◽  
pp. 759-763
Author(s):  
Randal C. Paniello ◽  
Julia D. Edgar ◽  
Joel S. Perlmutter
Keyword(s):  
Botulinum Toxin ◽  
Primary Outcome ◽  
Botulinum Toxin Injection ◽  
Primary Outcome Measure ◽  
Adductor Spasmodic Dysphonia ◽  
Related Quality ◽  
Botulinum Toxin Injections ◽  
The Voice ◽  
Dose Injection

Objectives: The intensity of muscle activity immediately following intramuscular botulinum toxin injection may affect the clinical efficacy of the injection. We tested this effect in patients who underwent botulinum toxin injections for adductor spasmodic dysphonia. Methods: Patients were studied over 3 to 5 injection cycles. Cycle 1 was the baseline control; cycle 2 was randomized between a 1-hour reading aloud task (“exercise”) and a 24-hour period of complete voice rest. For cycle 3, the patient completed the task not performed in cycle 2. Patients who were willing to continue for cycles 4 and 5 repeated the experiment at one half the injection dosage. Efficacy was determined with a battery of voice recordings and clinical outcomes instruments administered via telephone at 2- to 4-week intervals. The primary outcome measure was the result of the Voice-Related Quality of Life (VRQOL) instrument. Results: Nine patients (8 women, 1 man) with a mean age of 60.8 years (range, 42 to 76 years) completed at least 3 injection cycles. The VRQOL results were significantly higher for cycles that followed the exercise task. The patients reported subjectively that these were some of the best injection cycles they had ever experienced. Some achieved equivalent results with the half-dose injection plus exercise. The VRQOL results after voice rest cycles were not significantly different from the patients' baseline cycles. Conclusions: These results support the conclusion that a period of intense vocalization immediately following laryngeal botulinum toxin injections improves the efficacy of the injection. Possible mechanisms are proposed.

P66 Should we be screening for depression and quality of life in all patients attending botulinum toxin injection clinics or just those with cervical dystonia?

2019 ◽  
Vol 90 (3) ◽  
pp. e40.1-e40
Author(s):  
R Mozdiak ◽  
R Lally ◽  
F Osei-Poku ◽  
J Alty
Keyword(s):  
Quality Of Life ◽  
Botulinum Toxin ◽  
Pilot Study ◽  
Cervical Dystonia ◽  
Botulinum Toxin Injection ◽  
Cross Sectional ◽  
Female Age ◽  
Meige Syndrome ◽  
Prevalence Of Depression

ObjectivesCervical dystonia (CD) is known to be associated with depression and low quality of life (QoL) but we know little about these measures in non-CD patients attending botulinum toxin clinics. The objective was to evaluate the prevalence of depression and low QoL in both CD and nonCD patients.DesignCross-sectional pilot study.SubjectsConsecutive patients attending teaching hospital botulinum toxin clinic.MethodsPatients completed the Beck’s Depression Inventory (BDI) questionnaire and a Recovering Quality of Life (ReQoL) scale. BDI and ReQoL scores of ≥17 and≤24 indicated depression and impaired QoL respectively.Results48 patients (30 female; age 45–75 years) were evaluated; 33:15 CD:non-CD. The non-CD group comprised hemifacial spasm, upper limb dystonia/tremor, blepharospasm and Meige syndrome. 23% (11/48) of all patients had depression: 27% (9/33) of CD and 13% (2/15) of non-CD. Depression rates were more frequent amongst females and males (27%; 17%) (p=0.43). 34% of all patients had low QoL – 36% (12/33) and 27% (4/15) in the CD and non-CD groups respectively (p=0.51). Low QoL scores were more frequent in females (40%) than males (22%) but this difference was not significant (p=0.21).ConclusionsDepression and low quality of life were common in all patients in this pilot study. This suggests that screening of all patients attending botulinum toxin clinics, regardless of their diagnosis, may be clinically important. A larger study is required to validate these findings.

scholarly journals The Long-term Efficacy of Botulinum Toxin Injection to Treat Retrograde Cricopharyngeus Dysfunction

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2093834
Author(s):  
Rebecca C. Hoesli ◽  
Melissa L. Wingo ◽  
Robert W. Bastian
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Symptom Relief ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Case ◽  
Duration Of Action ◽  
Cricopharyngeus Muscle ◽  
Cardinal Symptoms

Objectives To report the percentage of patients with symptom relief 6 or more months after botulinum toxin injection into the cricopharyngeus muscle for retrograde cricopharyngeus dysfunction (R-CPD). Study Design Retrospective case series of consecutively treated patients. Setting Tertiary care laryngology clinic. Subjects and Methods A review was performed of the first 200 patients who were diagnosed with R-CPD and treated with botulinum toxin injection into the cricopharyngeus muscle by a single surgeon. The study group was limited to those for whom a minimum of 6 months has elapsed since the injection. Items assessed were efficacy, safety, complications, and duration of benefit. Results Of 200 patients treated, (99.5%) gained the ability to burp and 95% experienced relief of the cardinal symptoms of R-CPD: inability to belch, socially awkward gurgling noises, abdominal/chest pressure and bloating, and excessive flatulence. For those who experienced relief, 159 (79.9%) maintained a satisfactory ability to burp after 6 months. Of those who did not maintain the ability, 12 underwent a second injection, 1 patient underwent 3 subsequent injections, and 3 patients underwent partial myotomy. No patients experienced complications of botulinum toxin injection itself, and 4 patients had complications from esophagoscopy or anesthesia. Conclusion In a case series of 200 patients with retrograde cricopharyngeus dysfunction, 99% experienced relief of the cardinal symptoms and 79.9% experienced lasting relief of their symptoms beyond pharmacologic duration of action after a single injection of botulinum toxin into the cricopharyngeus muscle. Relief can be reestablished in the remainder via additional injection or cricopharyngeus myotomy.

Office-based Electromyography-guided Botulinum Toxin Injection to the Cricopharyngeus Muscle: Optimal Patient Selection and Technique

2017 ◽  
Vol 126 (5) ◽  
pp. 349-356 ◽  
Author(s):  
Min-Su Kim ◽  
Go-Woon Kim ◽  
Young-Soo Rho ◽  
Kee-Hwan Kwon ◽  
Eun-Jae Chung
Keyword(s):  
Botulinum Toxin ◽  
Cranial Nerve ◽  
Rating Scale ◽  
Botulinum Toxin Injection ◽  
Upper Esophageal Sphincter ◽  
Disability Rating Scale ◽  
Cricopharyngeus Muscle ◽  
Swallowing Rehabilitation ◽  
Disability Rating ◽  
Cricopharyngeal Dysfunction

Objectives: This retrospective study was carried out to investigate the effectiveness and safety of office-based electromyography-guided injection of botulinum toxin in the cricopharyngeus muscle of patients who did not show upper esophageal sphincter passage in a swallowing study in spite of maximal swallowing rehabilitation. Methods: Thirty-six patients who showed no or limited ability to oral feed after maximum swallowing rehabilitation were enrolled. Video fluoroscopic swallowing study, flexible endoscopic evaluation of swallowing, disability rating scale, penetration aspiration score, and National Institutes of Health swallowing safety scale were used in the evaluation of dysphagia. Results: Success was defined as nondependence on gastrostomy for patients who previously were dependent on gastrostomy and improvement in disability rating scale score after botulinum toxin injections. The total success rate was 63.9%. The complication rate was very low, with only 1 patient showing temporary unilateral vocal fold paralysis. Botulinum toxin injection was more effective in patients with cranial nerve IX or X palsy than in those without it ( P = .006). Conclusions: This procedure can be a simple, safe, and effective tool in patients with cricopharyngeal dysfunction after swallowing rehabilitation, especially for cranial nerve IX or X palsy.

The point-touch technique for botulinum toxin injection in adductor spasmodic dysphonia: quality of life assessment

2011 ◽  
Vol 125 (7) ◽  
pp. 714-718 ◽  
Author(s):  
S Morzaria ◽  
E J Damrose
Keyword(s):  
Quality Of Life ◽  
Botulinum Toxin ◽  
Assessment Tool ◽  
Botulinum Toxin Injection ◽  
Spasmodic Dysphonia ◽  
Life Questionnaire ◽  
Adductor Spasmodic Dysphonia ◽  
Related Quality ◽  
Pre Treatment

AbstractBackground:Botulinum toxin injection under electromyographic guidance is the ‘gold standard’ for adductor spasmodic dysphonia treatment. The point-touch technique, an alternative injection method which relies on anatomical landmarks, is cheaper, quicker and more accessible, but has not yet gained widespread acceptance due to concerns about patient satisfaction.Objective:To assess swallowing and voice-related quality of life following point-touch botulinum toxin injection in adductor spasmodic dysphonia patients.Setting:Stanford University Voice and Swallowing Center.Design:Prospective case series (evidence level four).Methods:Consecutive adductor spasmodic dysphonia patients with a stable botulinum toxin dose–response relationship were recruited prospectively. The Eating Assessment Tool and Voice-Related Quality of Life questionnaires were completed pre-treatment and at 10 and 30 per cent completion of the injection cycle, respectively.Results:Thirty-seven patients completed follow up. The mean total botulinum toxin dose was 0.88 units. Pre-treatment Voice-Related Quality of Life questionnaire results reflected the burden of disease. Post-treatment Eating Assessment Tool and Voice-Related Quality of Life questionnaire results were collected at 2.53 and 7.84 weeks, respectively; the former showed an increase in dysphagia, albeit statistically insignificant, while the latter showed significantly improved scores (both domain and total).Conclusion:The point-touch technique is a viable alternative for botulinum toxin injection in the treatment of adductor spasmodic dysphonia.

scholarly journals Non-motor disorders in cervical dystonia

2018 ◽  
Vol 10 (3) ◽  
pp. 135-140 ◽  
Author(s):  
V. A. Tolmacheva ◽  
M. R. Nodel ◽  
N. I. Saloukhna
Keyword(s):  
Quality Of Life ◽  
Botulinum Toxin ◽  
Mental Disorders ◽  
Cervical Dystonia ◽  
Botulinum Toxin Injection ◽  
Injection Therapy ◽  
Motor Disorders ◽  
Improve Quality ◽  
Perceptual Disorders

Botulinum toxin injection therapy is the mainstay for managing patients with motor manifestations of dystonia. It is important to identify possible cognitive and mental disorders, sleep and perceptual disorders (non-motor disorders) in these patients. Correction of these disorders will be able to optimize treatment and to improve quality of life of patients. 

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