Treatment of Ventricular Dysphonia With Botulinum Toxin

Abstract

Ventricular dysphonia, traditionally known as dysphonia plica ventricularis, is a voicing disorder in which the false vocal folds are used as a vibratory source in addition to or instead of the true vocal folds. Traditional treatment of ventricular dysphonia has been voice therapy, which may be slow to produce results if the false fold activity masks an underlying problem of the true folds, is long standing, or has produced hypertrophy of the supraglottic structures. We present seven cases of ventricular dysphonia treated with botulinum toxin injection into the false vocal folds followed by speech therapy. The addition of botulinum toxin to the treatment regimen speeds recovery of normal voicing and allows immediate evaluation of dynamic true vocal fold function by the treating professional.

Ventricular Dysphonia: Clinical Aspects and Therapeutic Options

“…This may have caused true vocal cord weakness and compensatory false vocal fold hyperadduction during phonation. Because the injection of botulinum toxin at the lateral posterior margin of the ventricular folds near the junction with the aryepiglottic folds resulted in a relaxation of the false vocal folds and the supraglottic region, Kendall and Leonard 7 thought that, next to the involvement of the thyroarytenoid muscle, the lateral cricoarytenoid muscle is also accountable for the sphincteric contraction of the false vocal cords. Normally, the ventricular folds adduct with the arytenoid cartilages and assist in laryngeal closure.…”

“…Sometimes, constriction of aryepiglottic folds can be discovered during laryngoscopy. 2,3,6,7,10,12 Microlaryngoscopy enabled Kosokovic and Lenarcic‐Cepelja 4 to investigate the ventricular folds and their (hypertrophic) mucosa. Coronal x‐ray tomography of the vibration sites is the only sure way to identify the vibrating structures used as phonatory source.…”

“…In this case, improvement of the characteristics of ventricular phonation should be pursued by enhancing and controlling the respiration, increasing open mouth posture and precise articulation, and promoting resonance. 7,8,12 Otherwise, if true vocal fold vibration is possible (even during nonphonatory tasks, such as humming, inspiratory phonation, or phonating while whistling), various therapeutic options are to be introduced. Table III represents an inventory of different (combined) treatment approaches with their outcomes.…”

“… 2–5 The estimated incidence of hoarseness following ventricular phonation is 4%. 6 Based on Voelker's study, 27 including 2000 college men, Kendall and Leonard 7 reported a prevalence of Vd of 6%. Although the ventricular folds physiologically move with the arytenoid cartilages and are brought together assisting in glottic airway closure, 3 they do not approximate the median line (covering the true vocal folds) during normal voice production and they normally do not participate in vocal vibration.…”

The application of botulinum toxin in oromandibular, pharyngeal and laryngeal dystonia

“…Der optischen Kontrolle wird die größe-re Sicherheit zugesprochen [4]. Des Weiteren ist eine Mitbehandlung des M. ventricularis bei Adduktionsspasmen der Taschenfalten nur unter optischer Kontrolle möglich, weil der Taschenfaltenmuskel keiner elektromyographischen Kontrolle zugänglich ist [15,28].…”