Botulinum Neurotoxin for Failed Tracheoesophageal Speech: Phonatory and Functional Voice Outcomes (Report‪)‬

Keywords: botulinum toxin; laryngectomy; hypertonicity; phonation; Voice Handicap Index Prior research supports the use of botulinum toxin to improve phonatory duration for laryngectomy patients with failed tracheoesophageal speech (TES) caused by hypertonicity or spasm of the pharyngoesophageal (PE) segment. However, few studies to date have examined its impact on connected speech, and no studies have explored whether treatment has a positive impact on psychosocial function. In the current study, the effects of botulinum toxin injection as a voice restoration technique were examined in seven laryngectomy patients with failed TES as a result of PE segment hypertonicity with or without spasm. Preinjection and at five times postinjection (2 weeks; 3, 6,12, and 24 months) participants underwent perceptual assessments of phonatory duration, phonatory fluency in conversation, and completed the Voice Handicap Index (VHI), a voice-related functional impact measure. Results revealed improvements in phonation duration, phonation duration per breath, and VHI score for all participants and improvements in conversational voice fluency for four participants post injection. Three participants experienced botulinum toxin failure and required reinjection during the study period. Botulinum toxin injection into the hypertonic PE segment is an effective technique to help restore phonatory function, improve phonation in connected speech, and reduce the negative impact of impaired voicing on everyday life for individuals with nonfluent TES.