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Botulinum toxin injections for new onset bilateral vocal fold motion impairment in adults§


  • Presented at the American Laryngological Association Combined Otolaryngology Spring Meetings, Phoenix, Arizona, U.S.A., May 28–31, 2009.

  • This study was performed in the Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University, and the Department of Otolaryngology, University of California, San Francisco Voice and Swallowing Center.

  • §

    Disclosure of Potential Conflict of Interest: The authors have no funding, financial relationships, or conflicts of interest to disclose.



Review of clinical experience and results using botulinum toxin type A (BTX) for the management of adult patients with respiratory compromise due to new onset bilateral vocal fold motion impairment (BVFMI).

Study Design:

Retrospective case series.


The records of 11 patients from two institutions with respiratory compromise due to bilateral vocal fold motion impairment were reviewed. Age, sex, etiology of motion impairment, subjective response to BTX injections, changes in pulmonary function studies pre- and postinjection when available, the dosage of botulinum toxin required to achieve response, the number of injections per patient, and complications were reported.


All patients were over 18 years old. There were three male and eight female subjects. The etiology of BVFMI was due to previous anterior cervical surgery in nine patients and prolonged intubation in two. Ten patients reported symptomatic improvement and returned for an average of nine injections over the 10-year period of study. The most common interval between injections was 3 months. In all patients the dose required to achieve symptomatic improvement was at least 2.5 mouse units injected into each vocal fold. One patient without relief of symptoms had bilateral cricoarytenoid joint fixation. Complications were limited to moderate dysphagia in one patient and breathy dysphonia in all patients.


BTX injection into the vocal folds provides temporary relief of symptoms in airway obstruction in adult patients with BVFMI. Patients require an average of 2.5 units of botulinum injection into each vocal fold and have an average length of response of 3 months. BTX injection may be used as a form of temporary relief of airway obstruction in patients wishing to avoid ablative surgery or tracheotomy. Laryngoscope, 2010