BOTULINUM NEUROTOXIN INJECTION AFTER TOTAL LARYNGECTOMY

Background: One of several causes of tracheoesophageal puncture (TEP) speech failure after total laryngectomy is disturbance in relaxation o f the pharyngoesophageal (PE) segment. We introduce the use of chemica l denervation of the PE segment through botulinum neurotoxin (Botox(R) ) injection to improve TEP speech. Methods: An analysis was performed on eight patients who received Botox(R) injections for TEP speech prob lems after total laryngectomy at the University of Iowa between June 4 , 1991 and August 8, 1994. Retrospective chart review identified the e volution of pretreatment evaluation and injection technique which beca me standardized in April 1992. Prospective evaluation of results was r ecorded by a single speech pathologist who subjectively identified the response to Botox(R) in all patients and recorded pressure readings a t the tracheostoma site during speech in 6 patients. Results: Seven of the eight patients were noted to have improved TEP speech following i njection. Five of these seven patients experienced substantially impro ved speech, three of whom had no ability to produce speech prior to th e Botox(R) injection. Conclusion: Botox(R) injection is a safe and eff ective method of improving TEP speech in selected patients with distur bed relaxation of pharyngoesophageal segment. (C) 1997 John Wiley & So ns, Inc.