S200 – Ventricular Folds in Laryngeal Dystonia Treated with Botox

Abstract

Objectives

Analyze the behavior of Vestibular Folds(VF) in Adductor Laryngeal Dystonia(ALD) after and before the treatment with unilateral botulinum toxin injection(BTX) during different laryngeal tasks, comparing treated side(IPSI) and opposite side (CLT).

Methods

23 patients with adductor laryngeal dystonia were studied retrospectively. Categorical data were obtained about ventricular fold medial compression from qualitative judgment of the flexible laryngoscopic dynamic examination. It was realized after and before BTX comparing the compression grade of VF in IPSI with CLT. The VF medial compression was graduated in 4 points scale. The tasks were sustained phonation of /e/ and /i/, during inspiration, soft breathing, whispering, emissions with voiceless sounds and voiceful sounds, sniff and whistling. McNemar and Wilcoxon tests were used to statistical analysis.

Results

Statistical significance was noted on improvement of medial compression of CLT and on reduction of medialization of IPSI as follow: soft breathing (IPSI: p=0,031^* CLT: p=0,039^*), sustained /e/ (IPSI: p<0,001^* CLT: p=0,001^*), sustained /i/ (IPSI: p=0,012^* CLT: p<0,001^*), phonation with voiceful souds (IPSI: p<0,001^*) and voiceless souds (IPSI: p<0,001^*). The whispering (IPSI: p=0,001^* CLT: p=0,057) and the whistling (CLT: p=0,125) was significantly improved on IPSI, without significance at CLT. Phonation during inspiration and sniff didn't show significance.

Conclusions

Significant variation occur on VF behavior in ALD after BTX, with reduction of VF medialization in the IPSI in comparison with increased medialization of VF in the CLT, mainly at phonatory tasks and rest. This variation hasn't the same behavior at atypical and non-phonatory tasks.