Therapeutic Outcomes of Vocal Fold Botulinum Toxin Injections for Exercise-Induced Laryngeal Obstruction

To investigate the effectiveness of vocal fold botulinum toxin injection (BTI) for treating patients with the glottic form of exercise-induced laryngeal obstruction (EILO).

The outcomes of 13 patients treated with BTI for a confirmed diagnosis of EILO between May 2017 and July 2024 were retrospectively analyzed. Electromyography-guided bilateral BTI (1.5 IU Xeomin) was administered through the cricothyroid membrane approach. The BTI effectiveness was assessed at 3-month follow-up on the dyspnea and stridor. The number of BTIs, mean doses, and adverse events were collected.

The cohort included nine females and four males (mean age of EILO onset: 21 years), predominantly runners (n = 7), with all having reduced or stopped their high-intensity sport activities. Twelve patients (92.3%) reported symptom improvement after a single BTI, with the remaining patient responding to a second BTI with an increased dose. The mean duration of BTI effectiveness was 90 days (range: 30-180 days) for a mean follow-up period of 14 months. The mean number of BTI to reach a sustained symptom relief was 4.38. Transient mild aphonia occurred in 53.8% of patients following initial treatment.

Single or repeated BTIs into vocal folds are an alternative, safe, and effective procedure for treating isolated glottic EILO. Future large-cohort studies are needed to investigate its effectiveness on the long-term with comparison with voice therapy through multidimensional subjective and objective evaluations.