Botox Injection Combined With Partial Arytenoidectomy: A Novel Approach for Treatment of Episodic Laryngeal Breathing Disorders

Objective: The aim of this study was to develop effective treatments for episodic laryngeal breathing disorders (ELBD), a series of diverse obstructive 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, and laryngospasm. Methods: Five patients with ELBD were involved in this study (60-81 years, average of 70 years), including three men and two women, who visited the otolaryngology outpatient department suffering from dyspnea several times. Bilateral vocal fold paralysis and asthma were excluded. An injection of initial botulinum toxin into the vocal cords was treated for each patient. If recurrence were to take place within 3 months after injection, a vocal cord process resection would be performed. The visual scale of perception was used for assessing preoperative and postoperative dyspnea. Results: All patients experienced symptoms of recurring dyspnea for a duration of 1-120 months. The average follow-up duration was 14 months (6-24 months) after treatment. Dyspnea was relieved in two patients after the Botox injection alone. Three patients found relief after unilateral vocal cord process resection. All patients showed a significant reduction in postoperative dyspnea scale in VAS score. Conclusion: This study preliminarily explores the efficacy of combined Botox injection and partial arytenoidectomy as a therapeutic option for ELBD.