Pharyngeal Motility Before and After Thyroarytenoid Muscle Botulinum Toxin Injection
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ORIGINAL ARTICLE
Pharyngeal Motility Before and After Thyroarytenoid Muscle Botulinum Toxin Injection Welber Chaves Mororó1 · Fernando Augusto Herbella2 · Karine Valéria Gonçalves de Oliveira1 · Noemi Grigoletto De Biase1,3 Received: 8 July 2019 / Accepted: 3 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Botulinum toxin type A (BTA) injection in intrinsic laryngeal musculature may result in dysphagia and consequent loss of quality of life (QOL) in a percentage of patients. This study aims to evaluate pharyngeal motility as a putative cause for this change in swallow quality in light of high-resolution manometry (HRM). Twenty patients (95% females, median age 66 years) underwent high-resolution manometry before and after BTA injection. Dysphagia was evaluated based on a QOL dedicated questionnaire (SWAL-QOL) before and after BTA injection. Pharyngeal motility at the topography of the vellum, epiglottis, and upper esophageal sphincter (UES) were recorded. Eleven (55%) subjects had worsened QOL after BTA injection. In patients with worsened QOL, UES extension decreased (p = 0.005), UES residual pressure increased (p = 0.02), UES basal pressure decreased (p = 0.04), and velopharynx contraction duration decreased (p = 0.04). UES residual pressure increased (p = 0.01), velopharynx peak pressure (p = 0.04) and upstroke (p = 0.007) decreased in patients with maintained QOL. There was no difference between groups when comparing pre-injection values. UES extension (p = 0.01) and UES maximum relaxation time (p = 0.03) was lower in the group with worsened QOL after BTA as compared to no change in QOL. Pharyngeal motility as measured by HRM was not a predictor for post procedure dysphagia and the changes in motility after BTA injection does not seem to be a strong contributor to dysphagia. Keywords Deglutition disorders · Manometry · Botulinum toxin type A · Electromyography
Introduction Botulinum toxin type A (BTA) injection in the intrinsic laryngeal musculature is used for the treatment of different disorders, such as dystonia, essential voice tremor, vocal fold granuloma, stuttering, and posterior glottic synechia [1]. Dysphagia may result in 5 to 45% of the cases as a side effect of the injection [2–5]. This symptom may occur due to alteration of pharyngeal motility. * Welber Chaves Mororó [email protected] 1
Department of Ear, Nose and Throat, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Pedro de Toledo 947, Sao Paulo, SP 04038‑002, Brazil
Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP 04037‑003, Brazil
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Pontifícia Universidade Católica de São Paulo, Rua Monte Alegre 984, Sao Paulo, SP 05014‑901, Brazil
The pharyngo-upper esophageal area has been neglected during conventional manometry era. High-resolution manometry (HRM) renewed interested in this segment due to technological advances including circumferential disposition of the sensors and the ab
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