Videostroboscopy of the pharyngoesophageal segment in laryngectomy patients treated with botulinum toxin

OBJECTIVES: The purpose of this investigation was to use videostroboscopy t o study the physiologic and biomechanical effects of botulinum toxin (Botox ) injection on the pharyngoesophageal segment (PES) in total laryngectomy p atients with poor-quality tracheoesophageal puncture (TEP) voice caused by PES spasm. METHODS: The following was a prospective study. Videostroboscopy of the PES and videotaped recordings of patients performing TEP voice tasks were cond ucted before and after Botox injection of the PES, Ratings of videostrobosc opic and speech samples were performed by 3 blinded judges with extensive e xperience with this patient population. RESULTS: Perceptually, TEP voice was more fluent and less strained after in jection. Videostroboscopically, patients demonstrated improved PES volition al control and mucosal wave characteristics after Botox injection. CONCLUSION: Botox injection in total laryngectomy patients with poor-qualit y TEP voice caused by PES spasm provides improved physiologic and biomechan ical function of the PES, as demonstrated for the first time videostrobosco pically. These findings help explain the perceptual ratings of TEP voice im provement noted after Botox injection. Videostroboscopy can be used to prov ide diagnostic information to help confirm the clinical impression of PES s pasm, as well as to document the effects of Botox injection on PES function .