Improving voice quality in laryngectomy patients with botulinum toxin A

Tracheoesophageal (TEP) speech is the main voice rehabilitation method following laryngectomy. Pharyngoesophageal hypertonicity is one of the main causes for failure to achieve tracheoesophageal speech after laryngectomy. Botulinum toxin A (BTA) has been used to chemically denervate the pharyngeal musculature, and is an alternative to invasive surgical procedures. The aim of this work is to study the effectiveness and safety of this procedure.

A retrospective cohort study from 2019 to 2023 was performed of 20 patients with failure to achieve a functional tracheoesophageal voice following laryngectomy. These patients undergone local pharyngoesophageal segment BTA injection. A total of 100 units of BTA were injected at 6 different sites, 3 in each side. Perceptual ratings of voice quality were performed before and 72 h after BTA injection by a speech therapist using a 7-point equal-appearing interval scale.

Speech quality mean rating (μ) improved from 2.05 before to 4.55 after BTA injection (P = .004), 17 (85%) patients had an improvement in postinjection perceptual TEP speech quality ratings, with scores in the good-to-excellent range (5-6 in the 7-point equal-appearing interval scale) in 12 patients (60%). Three patients (15%) didn't improve their voice quality, two of them with no discernible TEP speech. No adverse effects were reported.

The majority of the patients enrolled in this study (85%) showed an improvement in TEP speech following BTA injection. This is a safe and effective method to improve TEP speech following laryngectomy.