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Further experience with Botox injection for tracheoesophageal speech failure.
J S Lewin1, J K Bishop-Leone, A D Forman
1Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 441, Houston, Texas 77030-4009, USA. jlewin@mdanderson.org
Head & Neck
|May 22, 2001
Summary
Botulinum toxin (Botox) injections effectively treat pharyngeal constrictor hypertonicity, enabling successful tracheoesophageal speech in most laryngectomy patients. This intervention offers a lasting solution with minimal need for repeat treatments.
Area of Science:
- Otolaryngology
- Speech Pathology
- Medical Interventions
Background:
- Pharyngeal constrictor hypertonicity is a common cause of failed tracheoesophageal (TE) speech post-laryngectomy.
- Botulinum toxin (Botox) injections are used to alleviate this hypertonicity, but objective data on outcomes are limited.
Purpose of the Study:
- To evaluate the effectiveness and duration of Botox injections for treating TE speech failure due to pharyngeal hypertonicity.
- To determine the rate of reinjection required to maintain speech production.
Main Methods:
- 23 patients with unsuccessful TE speech underwent an EMG-guided Botox injection.
- Hypertonicity was diagnosed via insufflation testing and confirmed with videofluoroscopy.
- Additional injections were administered if initial treatment did not result in fluent speech.
Main Results:
- 87% of patients (20/23) achieved fluent TE speech after Botox.
- Five patients required additional injections for sustained fluency.
- The longest duration of effect was 37 months; one patient needed reinjection after 5 months.
Conclusions:
- Botox injections are effective in relieving pharyngeal constrictor hypertonicity in select patients with TE speech failure.
- This treatment offers a viable option for achieving long-term speech success with infrequent reinjection.