DOES BOTULINUM TOXIN ALTER LARYNGEAL SECRETIONS AND MUCOCILIARY TRANSPORT

Localized botulinum toxin injection disrupts cholinergic transmission and has potential to cause focal dysautonomia. Mucociliary transport a nd laryngeal secretions are thought to be mediated in part by autonomi c, cholinergic transmission. We questioned whether patients who receiv e Botox(R) injection for adductor spasmodic dysphonia (ADSD) report po stinjection symptoms possibly related to altered mucociliary clearance or laryngeal secretions. Medical histories, audiotaped interviews, an d symptom ratings were retrospectively examined for 29 patients with A DSD who were followed after one or more Botox injections. Patients had received bilateral, percutaneous Botox injections of 2.5 units using an EMG-guided approach. One or more weeks after injection, four patien ts reported either burning, tickling, or irritation of the larynx/thro at, excessive thick secretions, or dryness. Symptoms recurred with sub sequent injections in two patients and were not associated with swallo wing difficulty. These symptoms are consistent with, but not diagnosti c of, the known effects of botulinum toxin on cholinergic, autonomic t ransmission.