{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T11:39:05Z","timestamp":1773488345779,"version":"3.50.1"},"reference-count":13,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T00:00:00Z","timestamp":1663545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this study was to quantitatively compare the effectiveness of unilateral and bilateral botulinum toxin A (BTX\u2010A) injections for mitigating undesirable weak\/breathy voice quality and dysphagia for patients with adductor spasmodic dysphonia and\/or essential tremor of voice (ETV).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were collected from the medical records of 319 patients, yielding three treatment cohorts: patients who received an equal dose bilateral injection regimen (BL=) throughout their course of treatment at VUMC, patients who switched to a unilateral injection regimen (UL), and patients who switched to an unequal dose bilateral injection regimen (BL\u2260). Changes in length of improvement, duration of weak\/breathy voice, and dysphagia severity were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The BL\u00a0=\u00a0treatment group reported the longest duration of improved voice. Shorter periods of improved voice were reported at baseline by patients who later switched to UL or BL\u00a0\u2260\u00a0injection regimens. Patients receiving UL injections reported significantly reduced weak\/breathy voice and dysphagia. Patients receiving BL\u00a0\u2260\u00a0injections reported increased length of improved voice; however, dysphagia symptoms increased. Ninety\u2010two percent of patients with ETV switched to a UL regimen, with 61% of patients transitioning within the first three injections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with pronounced dysphagia and extended periods of weak\/breathy voice may benefit from a UL injection approach to mitigate side effects from BTX\u2010A without sacrificing improved voice outcomes. For patients seeking to extend their length of improved voice, a BL\u00a0\u2260\u00a0injection regimen may be effective provided the adverse side effects from BTX\u2010A are minimal. Patients with ETV may benefit from a UL injection approach at the outset of their course of treatment with BTX\u2010A.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lio2.915","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T10:45:38Z","timestamp":1663584338000},"page":"1499-1505","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Optimizing <scp>Botox<\/scp> regimens in patients with adductor spasmodic dysphonia and essential tremor of voice: A <scp>31\u2010<\/scp>year experience"],"prefix":"10.1002","volume":"7","author":[{"given":"Amy","family":"Stone","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6643-8991","authenticated-orcid":false,"given":"Maria E.","family":"Powell","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5220-6567","authenticated-orcid":false,"given":"Kaitlyn","family":"Hamers","sequence":"additional","affiliation":[{"name":"Department of Hearing &amp; Speech Sciences Vanderbilt University  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Charles","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David O.","family":"Francis","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2010Head and Neck Surgery University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6885-2929","authenticated-orcid":false,"given":"Mark S.","family":"Courey","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Mount Sinai Health System  New York City New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James L.","family":"Netterville","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. Gaelyn","family":"Garrett","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head &amp; Neck Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2017.3088"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20101331.2010.03047.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348949810700403"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537\u2010199612000\u201000006"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892\u20101997(05)80038\u20104"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00186224"},{"issue":"3","key":"e_1_2_7_8_1","first-page":"171","article-title":"Unilateral versus bilateral botulinum toxin injections in spasmodic dysphonia: acoustic and perceptual results","volume":"22","author":"Adams SG","year":"1993","journal-title":"J Otolaryngol"},{"issue":"3","key":"e_1_2_7_9_1","first-page":"160","article-title":"A comparison of the efficacy of unilateral versus bilateral botulinum toxin injections in the treatment of adductor spasmodic dysphonia","volume":"23","author":"Maloney A","year":"1994","journal-title":"J Otolaryngol"},{"issue":"6","key":"e_1_2_7_10_1","first-page":"345","article-title":"Comparison of botulinum toxin injection procedures in adductor spasmodic dysphonia","volume":"24","author":"Adams SG","year":"1995","journal-title":"J Otolaryngol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892\u20101997(96)80012\u20109"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892\u20101997(02)00080\u20102"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1746\u2010160X\u20105\u201020"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820957608"}],"container-title":["Laryngoscope Investigative Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lio2.915","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lio2.915","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lio2.915","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T06:17:41Z","timestamp":1692685061000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lio2.915"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,19]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1002\/lio2.915"],"URL":"https:\/\/doi.org\/10.1002\/lio2.915","archive":["Portico"],"relation":{},"ISSN":["2378-8038","2378-8038"],"issn-type":[{"value":"2378-8038","type":"print"},{"value":"2378-8038","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,19]]},"assertion":[{"value":"2022-04-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}