Ear wiggling tics are a rare disorder and there is no reported satisfactory treatment. We had a patient present with ear wiggling tics, which we treated with injections (totaling 40 units) of botulinum toxin A to the pinna muscle (i.e., the auricularis anterior and superior). The tics completely disappeared within 9 days of injection without any side effects.

Objective To find the lowest effective injection dose of abobotulinum toxin A (Dysport) for allergic rhinitis. Study Design Dose‐escalation randomized controlled trial. Methods We included all patients aged 18 years or older who had persistent allergic rhinitis and positive allergy skin prick test. The patients were randomly allocated to receive 40, 30, or 20 U of abobotulinum toxin A by injection at the inferior turbinate. We followed up on patients for 12 weeks to evaluate nasal symptoms, ocular symptoms, minimum nasal cross‐sectional area as measured using acoustic rhinometry, and complications. Results Seventeen patients were included in this study, with 7 receiving 20 U of abobotulinum toxin A and 5 each receiving 30 U and 40 U. Abobotulinum toxin A significantly improved nasal congestion, rhinorrhea, sneezing, and loss of smell at 40 U (P < .05) and nasal congestion, sneezing, and loss of smell at 30 U (P < .05). However, at a dose of 20 U, only nasal congestion and loss of smell improved (P < .05). Nasal patency had also significantly improved two weeks after treatment at doses of 40 and 30 U (P < .05). Complications included epistaxis (11.8%) and nasal dryness (23.5%). Conclusion Abobotulinum toxin A at a dose of at least 30 U effectively reduced most nasal symptoms. Level of Evidence 2. Trial registration http://clinicaltrials.in.th/ TCTR20200526014.

Background: Botulinum toxin injections into the thyroarytenoid (TA) muscle of the larynx is the most popular treatment for adductor spasmodic dysphonia. Injection is usually done by percutaneous transcricothyroid membrane with either electromyography (EMG) or fiberoptic laryngoscopy (FOL) to verify placement of the needle within the TA muscle. This procedure requires a working knowledge of three-dimensional anatomy of the larynx to establish the direction for the accurate placement of the needle. Objective: Find out the appropriate angles and depth of the needle for placement of percutaneous transcricothyroid membrane method of botulinum toxin injection by means of studying the larynges of Thai cadavers. Methods: The descriptive study was performed in 45 Thai freshly thawed cadavers. The angle of the needle from midline sagittal plane, the angle in superior relation to tracheal plane, and the depth from midline cricothyroid (CT) membrane to midlength of TA muscle were measured from the two views of photographs, anteroposterior and lateral. Results: The mean angle of 24.2±6.76° (mean±SD) from the midline sagittal plane in male and 24.9±7.6° in female were worked out. A mean angle in superior relation to the tracheal plane was 47.7±7.8° and 51.4±9.6° in male and female, respectively. The mean depth was 1.7±0.2 and 1.4±0.1 cm in male and female, respectively. Conclusion: The mean angles and depth of the needle insertion from the midline of CT membrane to the center of TA muscle in Thai laryngeal specimens were evaluated. These values were different from the studies in Caucasians, but it could provide a direct relationship to the build of the races. This knowledge may help laryngologists do this procedure more accurately with better outcome, especially in hospitals that have no EMG or FOL guide.