Botox Injection Combined with Partial Arytenoidectomy; A Novel Approach for treatment of Episodic Laryngeal Breathing Disorders

Objective: The goal is to formulate effective treatment for episodic laryngeal breathing disorders (ELBD), a diverse range of respiratory disorders with an unknown pathogenesis. The diseases include Paradoxical Vocal Fold Motion/Movement Disorder (PVFMD), Vocal Cord Dysfunction (VCD), Irritable Larynx Syndrome (ILS), exercise-induced laryngeal obstruction, laryngospasm, Munchausen stridor, et al. Our research focuses on those patients experiencing severe episodes who do not respond to behavioral training and oral medication. We are investigating the effect of surgery or injections on episodic laryngeal breathing disorders.

Methods: Five patients with ELBD were involved in this study (60-81 years, average of 70 years), including three men and two women, recruited from January 2017 to April 2023, who visited the otolaryngology outpatient department suffering from dyspnea. Bilateral vocal fold paralysis was excluded. An initial Botox injection into the vocal cords was treated for each patient. If recurrence were to take place during the medication period, a vocal cord process resection would be performed. A clinician and patients, via the visual scale of perception, assessed both preoperative and postoperative dyspnea scales.

Results: All patients experienced symptoms of dyspnea for a duration of 1-120 months (maximum recorded case being ten years). The average follow-up duration was 14 months (6-24 months). Dyspnea was relieved in two patients after the Botox injection alone. Four patients found relief after unilateral vocal cord process resection. All patients showed a significant reduction in postoperative dyspnea scale in VAS score.

Conclusion: In our study, the Botox injection combined with partial arytenoidectomy provides a novel and potentially effective treatment for Episodic Laryngeal Breathing Disorders.