{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T19:13:27Z","timestamp":1773774807103,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2014,12,4]],"date-time":"2014-12-04T00:00:00Z","timestamp":1417651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Centers for Disease Control and Prevention guidelines maintain that single\u2010use vials cannot be used for multiple patients. Botox product labeling states that the reconstituted toxin should be used within 4 hours on a single patient based on concerns of reduced potency, contamination, and consequent infections. The purpose of this study was to determine the safety and efficacy of using single\u2010use vials in a multidose fashion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective study and cohort chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A multi\u2010institutional three\u2010part study was performed between May 2013 and October 2013: 1) a summation of subjects' recall of their past experiences (symptoms\/response) with previous multidose Botox injections, 2) a prospective study of intralaryngeal injections, and 3) a chart review of injection responses in a subset of the cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven hundred forty\u2010three subjects receiving 6,216 injections demonstrated zero infection\u2010related complications on retrospective chart review. One hundred seventy\u2010nine subjects recalled 24.0% overall adverse events, 10.6% redness, 7.3% pain and swelling at the injection site, and 0% fever. One hundred seventy\u2010four subjects prospectively reported 12.6% overall adverse events. The self\u2010reported efficacy rate of Botox injection was 96.6%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The low rates of adverse events following the use of Botox in a multipatient fashion are consistent with other percutaneous injections. No evidence of infection was found with multidose Botox use. Given the low incidence of side effects and high success rate, Botox can be used both safely and effectively in a multipatient fashion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 125:1149\u20131154, 2015<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.25068","type":"journal-article","created":{"date-parts":[[2014,12,6]],"date-time":"2014-12-06T15:09:34Z","timestamp":1417878574000},"page":"1149-1154","source":"Crossref","is-referenced-by-count":16,"title":["Safety and efficacy of multiuse botulinum toxin vials for intralaryngeal injection"],"prefix":"10.1002","volume":"125","author":[{"given":"Emily M.","family":"Barrow","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clark A.","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edie R.","family":"Hapner","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeanne L.","family":"Hatcher","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Health Science Center at San Antonio San Antonio Texas U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blake","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Texas Health Science Center at San Antonio San Antonio Texas U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"III","given":"Michael M.","family":"Johns","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Emory University School of Medicine  Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,12,4]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.4-3-258"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2006.04.001"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042533312472115"},{"key":"e_1_2_6_5_1","unstructured":"Botox [package insert]. 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