Vocal Cord Botox Injections to Treat Asthma???

Yup... It's true...

A clinical trial is under way in Australia to see if botox injections to the vocal cords can improve the shortness of breath some asthmatics have. Though nobody disputes that asthma is a pulmonary problem, it is not uncommon that the vocal cords in asthmatics may be dysfunctional exacerbating the breathing problem.

What is meant by dysfunctional? It's when the vocal cords come together when the person is trying to breath. It is also known as paradoxical vocal cord motion, vocal cord dysfunction, or laryngospasm at its worst. Read more here.

Botox injections will paralyze the vocal cord muscles preventing the vocal cords from coming together thereby allowing easier airflow into the lungs... or at least that's the hope. This procedure is commonly performed in patients suffering from spasmodic dysphonia and the technique used to treat these patients would be the same as that proposed for asthmatics. Watch a video here on how this is performed.

What's the downside? Aspiration, breathy voice, and trouble swallowing are common but temporary side effects. Problem is if aspiration occurs in a patient with significant pulmonary compromise, it can potentially be devastating leading to asthma exacerbation and even pneumonia.

Read a news article regarding this clinical trial here.

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Distributed Botox Injection for Spasmodic Dysphonia (Rather than Single Injection)

For many patients with spasmodic dysphonia, botox injections to the vocal cords are a regular right of passage every few months towards a clearer voice. Spasmodic dysphonia characterized by spastic or breathy voice breaks while talking causes much problems socially as well as misunderstandings.

For many physicians who perform botox injections for spasmodic dysphonia, a single injection is performed to either one or both vocal cords.

However a few and perhaps growing number of physicians are now using a more sophisticated method of injection where not only one, but multiple "mini"- injections are performed to the vocal cord during an injection.

Why would multiple injections be performed when one will do?

For that, I would like to take the reader to the world of cosmetic botox injections for facial wrinkles.

For the millions more sufferers of facial wrinkles, patients know that from the point of injection, there is a limited region of affect... typically no more than a dime to nickle area in size depending on the volume used. SO... in order to get rid of forehead wrinkles, 5 or more injections are required as shown here by the "x" marks.

The point is... in order for a great outcome in forehead wrinkles... multiple injections are performed. Not one single injection.

The same holds true for the vocal cord muscles. Rather than a single large injection to one spot in the vocal cord muscle, there is a growing belief that multiple "mini"-injections should be performed throughout the vocal cord muscle in order to produce a better outcome... a distributed injection. No specific research to prove this, but rather anecdotal.

Here is a video of botox being injected in a patient with spasmodic dysphonia.

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There are FOUR Different Types of Botox Available in the Market

Not many people know that there are FOUR different types of botox available and FDA approved for use in the United States.

The four botox products are as follows:

1) Botox by Allergan
2) Myobloc by Solstice Neurosciences
3) Dysport by Ipsen, Ltd
4) Xeomin by Merz

Obviously, Botox by Allergan was the first and most popular to the point where its product name "botox" is being used interchangeably to mean any botulinum toxin product; much like "Kleenex" is used to mean any tissue product to blow the nose with or "Google" to mean "to search for" even if you use Bing.

Although all four products are made from the Clostridium botulinum bacteria, the four products are isolated from different strains of bacteria, have different molecular structures, and attach to different parts of the nerve. What does this mean for the end-user? It means that dosages are not equivalent across product lines. In other words, 1 unit of botox is NOT the same as 1 unit of myobloc. Furthermore, duration of effect may be different as well as immune response.

Also as an FYI, Botox, Xeomin, and Dysport are Botulinum toxin type A whereas Myobloc is type B.

Dr. Chang performs botox injections for a variety of problems using Botox by Allergan.

At least for spasmodic dysphonia, the conversion factor is 52.3:1 Myobloc (BTX-B) to Botox (BTX-A)

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Botox - A National Security Threat???

Botox which is commonly used for cosmetic and medical reasons can also pose a national security threat according to a story in the June 2010 Scientific American.

Before this claim can be dismissed out-of-hand, consider that consumer demand for botox is fueling a proliferation of illegal botox distributors. Botox, which is botulinum toxin made by a bacteria in food gone bad, is actually a lethal poison which could potentially be used as a potent biological weapon in large enough quantities. Illegal botox distributors in their quest to make more money can sell botox to terrorists (or be terrorists themselves selling to make money to fund its use as a weapon).

Read more about the story here. Read a LA Times article here.

Read more about illegal botox distributors here.

On a lighter note, Dr. Chang performs botox injections for both cosmetic and medical purposes including facial wrinkles, torticollis, spasmodic dysphonia, etc. See the complete list here. We purchase our botox directly from Allergan, the manufacturer of botox.

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Botox for Chronic Cough

There was a new report in the May 2010 issue of Archives of Otolaryngology-Head & Neck Surgery that discussed the use of botox to achieve significant improvement, if not cure, in adult patients with a chronic cough due to sensory neuropathy. In this report titled "Use of Botulinum Toxin Type A for Chronic Cough: A Neuropathic Model", there are 4 case studies that were presented. The results they reported stated that cough relief occurred after a median of 7 injections with a mean dose of 4.0 Units per treatment session for a mean duration of 25.7 months. To watch a video of how the botox is injected into the voicebox to treat chronic cough, click here or watch below (the procedure is the same as that performed for spasmodic dysphonia).

Of note, this is the 2nd report on use of botox for chronic cough, the first was published in 2007 in ENT Journal and was done on kids. Click here to read that report.

I tend to use botox as a last resort when other medical management strategies have failed. Hidden triggers of cough including reflux, allergies, and asthma need to be addressed prior to consideration of botox. Often, I'll give a trial of neuropathic medications if laryngeal sensory neuropathy is suspected.

To read more about chronic cough, click here.

To read the actual report on use of botox to treat chronic cough, click here.

Botox is performed by Dr. Chang every Friday afternoon for spasmodic dysphonia, laryngospasm, as well as chronic cough! We also use botox for migraines, facial wrinkles, and torticollis.

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Doctor Sentenced to 5+ Months Jail For Using Non-FDA Approved Botox on Patients

A Houston physician, Dr. Gayle Rothenburg, was sentenced to 5½ months in federal prison on April 16, 2010 for injecting patients with a Botox product not approved by the Food and Drug Administration for human use. Read the full story here.

She did this in order to save money at the expense of patient safety.

Please note that in our office, we use ONLY the brand-name BOTOX made by Allergan Corporation. In fact, we purchase our BOTOX directly from Allergan Corporation and not through a third party supplier.

Always ask your doctor where they get their BOTOX from and make sure you are happy with their answer (buyer beware)!

Read more about this story here.

To see a full list of procedures we perform with BOTOX, click here.

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Botox Treatment for Vasomotor Rhinitis (Idiopathic or Non-Allergic Rhinitis)

A new research paper has been published Oct 16, 2009 in Head & Face Medicine entitled "Minimally invasive application of botulinum toxin A in patients with idiopathic rhinitis" in which researchers successfully treated patients with a persistent runny nose not due to any known problems like allergy. Such a condition is called vasomotor rhinitis or idiopathic rhinitis or non-allergic rhinitis.

In this new described method of treatment, a sponge soaked with 40 Units of botulinum toxin type A was inserted into a patient's nose and left in place for 30 minutes. Apparently, this did result in a significant reduction in rhinitis (but not congestion) and lasted for as long as 12 weeks.

Read the abstract here.

Of course, this is a non-FDA approved use of Botox.

Historically, this condition is often treated with nasal sprays (ie, astelin) and decongestants with some success in some patients, but not all patients respond.

Surgical treatment include turbinate reduction which reduces (usually about 50%), but does not cure this condition.

Before you ask... NO we do not offer this procedure until further research and data becomes available.

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