Efficacy of Botulinum Toxin Injection into Posterior Cricoarytenoid Muscles for the Management of Aspiration in Bilateral Adductor Vocal Fold Paralysis: A Case Series.

OBJECTIVE

Bilateral adductor vocal fold paralysis (BAVCP) is a rare condition causing dysphonia and aspiration. Botulinum toxin (BTX) injection has been proposed as a reversible bridging therapy for temporary and permanent cases. This study evaluates voice and swallowing outcomes after BTX injection into the posterior cricoarytenoid (PCA) muscle in patients with BAVCP.

METHODS

Ten patients (nine female, one male; age 19-69 years) with BAVCP underwent PCA BTX injection. Functional outcomes included Maximum Phonation Time (MPT), Penetration-Aspiration Scale (PAS), and vocal fold gap measured by flexible laryngoscopy. Assessments were performed pre-injection and at 4 weeks postinjection.

RESULTS

Mean PAS score improved from 7.0 (6-8) pre-injection to 4.1 (2-6) postinjection (P = 0.0056). Mean MPT increased from 1.4 seconds (1-2) to 4.1 seconds (3.7-4.9) (P = 0.0057). Glottic gap decreased from 8 mm (7-9) to 4 mm (3-5) (P = 0.0019). All patients experienced swallowing improvement; dyspnea was not observed. Temporary paralysis cases required a single injection, while permanent cases needed repeated injections every 3-5 months.

CONCLUSIONS

PCA BTX injection in BAVCP is a safe, reversible method that improves voice and swallowing. It can serve as a bridging therapy in temporary paralysis and a functional-preserving treatment in permanent cases.