Further experience with Botox injection for tracheoesophageal speech failure

Background. Some patients fail to acquire tracheoesophageal (TE) speech aft er laryngectomy because of pharyngeal constrictor hypertonicity. Botox inje ction relieves hypertonicity, but there are little objective data regarding outcomes, duration of effect, and reinjection rates. Methods. Hypertonicity was identified by means of insufflation testing and confirmed videofluoroscopically in 23 unsuccessful TE speakers. Each patien t received an EMG-guided Botox injection. Additional injections were offere d ii the first injection failed to produce fluent speech. Results. Overall, 20 of 23 patients (87%) achieved fluent TE speech product ion after Botox injections; 5 after additional injections. Two patients dec lined further intervention, and 1 failed to achieve fluent TE speech produc tion even after 3 Botox injections. The longest sustained effect was 37 mon ths, the shortest was 5 months for 1 patient who required reinjection of Bo tox to maintain her TE speech production. Conclusions. Botox injection relieves constrictor hypertonicity in selected cases of TE speech failure with little need for reinjection to maintain lo ng-term speech success. (C) 2001 John Wiley & Sons, Inc.