What is Botulinum Toxin?
Botulinum toxin is also identified as the miracle poison, and it is among the most poisonous substances. It is produced by the bacteria known as Clostridium botulinum, which is a gram-positive, anaerobic, and spore-forming rod mainly found in water, plants, animals’ intestinal tracts, and soil. This neurotoxin has been in use since the late 1970s and is grouped into seven serotypes A to G (Satriyasa, 2019). Serotype A has three sorts, and serotype B has only one. These four types of serotypes have been approved all over the world for use in treating spasmodic torticollis, which is a condition that results in abnormal head movements. The other three serotypes A have been approved for use in the treatment of focal dystonia, which affects the eye leading to abnormal closure or twitching of the eyelid.
The FDA approved the toxin for use in managing migraines, the only chronic condition approved for treatment. The therapeutic effect of botulinum toxin is derived from its ability to reduce muscle tension, promoting its relaxation (Satriyasa, 2019). Onabotulinumtoxin A is a popular cosmetic that is used in cosmetic procedures. All the stereotypes are used to work by blocking acetylcholine which interferes with neural transmission. When botulinum toxin is used as the neuromuscular junction, it results in paralysis through the inhibition of acetylcholine.
Medical uses of BOTOX
Botulinum toxin has had various medicinal uses since its identification. It is used to treat blepharospasm, also known as eyelid spasms. The toxin is used to cause temporary paralysis, which blocks the communication of the nerves with muscles (Kumar, 2018). FDA approved Botox use in the treatment of eyelid spasms in 1989. Individuals suffering from blepharospasms cannot communicate with the basal ganglia, a part of the brain that maintains eye movements. It is also used in the treatment of strabismus (crossed eyes). This condition results from trauma such as blunt or childhood congenital problems (Kumar, 2018). Although it can be corrected through surgery, Botox can be used to check the look of the eye and as a long-term solution.
Spasmodic dysphonia is a medical condition where the sounds from the vocal cords are hoarse, shaky, or strained. It is perceived as a speech disorder despite being a neurological problem. Individuals suffering from this condition receive abnormal signals that affect their voice. Botox manages this condition by injecting it into the vocal cords, weakening the muscles and producing a smooth and soft voice. Botox is helpful in the management of hypersalivation, where the patient is administered through the throat, ear, or nose (Kumar, 2018). It can also be done by injecting the salivary glands, paralyzing the nerves and preventing them from producing excess saliva.
BOTOX for Voice Disorders
Spasmodic dysphonia, or laryngeal dysphonia, is a voice disorder that results from spasms of laryngeal muscles. The spasms can lead to untimely opening or closure of the glottic inlet. Adductor spasmodic dysphonia causes laryngeal dystonia, which promotes untimely speech breaks. This issue may elevate hence resulting in hypophonia or a breathy voice (Sapienza & Hoffman, 2018). The spasmodic dysphonia symptom is managed by injecting Botox into the intrinsic laryngeal muscle. This method is preferred because of its success rates as well as having minimum side effects. In managing adductor spasmodic dysphonia (ADSD), Botox can be injected bilaterally or unilaterally into the muscles (Sapienza & Hoffman, 2018). However, unilateral injection is preferred as it reduces side effects such as hoarseness and persistent breathing.
Furthermore, the unilateral injection has positive effects in women compared to men. When Botox is used, it denervates the muscles by inhibiting the release of acetylcholine. After a significant period, the affected nerve endings recover with gradual spasmodic symptoms (Sapienza & Hoffman, 2018). However, in ADSD, the symptoms of uncontrolled spasmodic are eliminated, which are responsible for the voice symptoms. Individuals with essential voice tremors present during the prolongation of vowels, which occur in cycles of 4 to 6 Hz, can also use Botox for its management (Sapienza & Hoffman, 2018). Essential tremors are identified by voice breaks and pitch breaks linked with large larynx tremors.
Risks and Side Effects of BOTOX
Botox’s use in managing voice disorders has minimal side effects as it is used in small quantities. The side effects are associated with Botox’s purpose, which is weakening the vocal cords. The first week of using Botox results in side effects such as coughing or choking when using drinks like water and other thin liquids (Yershov & Partridge, 2020). The effect is usually similar to taking water to a different pipe. At first, one may cough after the injection, which may last for weeks. Voice weakening is also a key side effect that occurs significantly after using the injection (Yershov & Partridge, 2020). This results from weakening the vocal cords after injection and cannot provide a strong vibration that is supposed to produce sound. However, the issue fades with time as it is meant to minimize the spasm effect.
How one breathes effectively, as well as the period of normal voice, relies on a person’s reaction to Botox and the dose used. A large dose of Botox results in a long breathy voice, promoting long spasm prevention. Swallowing problems also occur after using Botox as a vocal cord serves more than one voice production role (Yershov & Partridge, 2020). Vocal cords also prevent food from entering the airway during swallowing. However, Botox makes its muscles weak, making them less reliable and promoting aspirations.
BOTOX Treatment Process for Voice Disorders
Botox treatment involves three key techniques which are used for accessing laryngeal musculature. The techniques include visualization, EMG-guided percutaneous injection, and laryngoscopy-guided percutaneous injection (Biello et al., 2023). The anesthesia is applied to the nasal cavity, and the physician inserts a video endoscope through the nasal until a clear view of the glottis is identified. A lidocaine solution is instilled through the passage drop by drop into the vocal folds. A flexible needle within a protective sheath is then inserted as the surgeon ensures stabilization of the needle trajectory and the position of the endoscope (Biello et al., 2023). With direct visualization, botulinum toxin is then inserted into the affected area. Intralaryngeal leakage is prevented by mucosa blanching at the site of interest. Reflux is minimized by leaving the needle for 15 seconds before removing it.
EMG-guided percutaneous injection involves the indirect gain of the laryngeal movement disorder without using direct visualizations. In treating ADSD, an EMG needle is passed transcutaneously through a cricothyroid membrane 2 to 3 mm from the area to be addressed (Biello et al., 2023). The needle is maneuvered superolateral until crisp motor units are read. When positioned in TA muscles, a patient will be required to phonate for confirmation which then allows injection of Botox. The laryngoscopy-guided percutaneous injection is a direct way to visualize the larynx transcutaneously (Biello et al., 2023). Tropical anesthesia containing lidocaine passed through the nasal cavity using a flexible video nasolaryngoscope. A 27-gauged needle is then used to inject botulinum toxin.
Resources
Biello, A., Volne, K., & Song, S. A. (2023). Laryngeal Botulinum Toxin Injection. National Library of Medicine. Web.
Kumar, R. (2018). Therapeutic use of botulinum toxin in pain treatment. Neuronal Signaling, 2(3), 1–12. Web.
Sapienza, C. M., & Hoffman, B. (2018). Voice disorders (3rd ed.). Plural Publishing.
Satriyasa, B. K. (2019). Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect. Clinical, Cosmetic and Investigational Dermatology, 12, 223–228. Web.
Yershov, D., & Partridge, R. (2020). A life-threatening delayed complication of botulinum toxin injection for the treatment of spasmodic dysphonia. Prague Medical Report, 121(2), 114–117. Web.