{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:06:34Z","timestamp":1792713994530,"version":"4.5.0"},"reference-count":11,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,3,27]],"date-time":"2013-03-27T00:00:00Z","timestamp":1364342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2013,6]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the effect on voice improvement and duration of breathiness based on initial dose of onabotulinum toxin A (BTX\u2010A) in the management of adductor spasmodic dysphonia (SD) and to compare voice outcomes for initial bilaterally injected doses of 1.25 units (group A) vs 2.5 units (group B) of BTX\u2010A.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Case series with chart review of patients with adductor SD treated at a tertiary care facility from 1990 to 2011.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Academic subspecialty laryngology practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Demographic data (age and sex), voice rating, duration of voice improvement, and breathiness were evaluated and compared between groups A and B using the Student <jats:italic>t<\/jats:italic> test and \u03c7<jats:sup>2<\/jats:sup> analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 478 patients identified, 305 (223\u00a0in group A, 82\u00a0in group B) patients met inclusion criteria. The average age was 56.2 years in group A and 57.4 years in group B (<jats:italic>P<\/jats:italic> =. 5). The female to male ratio was 2.91 for group A vs 3.56 for group B (<jats:italic>P<\/jats:italic> =. 61). Good voice outcomes (grade 3 or 4) were reported by 91% of group A patients vs 94% of group B (<jats:italic>P<\/jats:italic> =. 75). The average duration of voice improvement was 99.7\u00a0days for group A and 108.3\u00a0days for group B (<jats:italic>P<\/jats:italic> =. 54). The average duration of breathiness was 10.88\u00a0days for group A vs 15.42\u00a0days for group B (<jats:italic>P<\/jats:italic> =. 02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients injected with 1.25 units bilaterally had a statistically significant shorter duration of breathiness without a statistically significant difference in clinical effectiveness or voice outcome. It is therefore recommended that a relatively low initial BTX\u2010A dose be used with subsequent titration to achieve improved voice outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599813484685","type":"journal-article","created":{"date-parts":[[2013,3,27]],"date-time":"2013-03-27T23:39:14Z","timestamp":1364427554000},"page":"1003-1006","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Considerations for Initial Dosing of Botulinum Toxin in Treatment of Adductor Spasmodic Dysphonia"],"prefix":"10.1002","volume":"148","author":[{"given":"David E.","family":"Rosow","sequence":"first","affiliation":[{"name":"Department of Otolaryngology University of Miami Miller School of Medicine Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punam","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Miami Miller School of Medicine Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Vivero","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Miami Miller School of Medicine Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy R.","family":"Casiano","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Miami Miller School of Medicine Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna S.","family":"Lundy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Miami Miller School of Medicine Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,3,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2011.08.011"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.2758-10.2011"},{"key":"e_1_2_9_4_1","first-page":"237","article-title":"Laryngeal dystonia (spasmodic dysphonia): observations of 901 patients and treatment with botulinum toxin","volume":"78","author":"Brin MF","year":"1998","journal-title":"Adv Neurol"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348948509400111"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0163-8343(88)90099-0"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348947608500405"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181ca00ca"},{"key":"e_1_2_9_9_1","first-page":"1300","article-title":"Botulinum toxin (BOTOX) for the treatment of \u201cspastic dysphonia\u201d as part of a trial of toxin injections for the treatment of other cranial dystonias","volume":"96","author":"Blitzer A","year":"1986","journal-title":"Laryngoscope"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940711601204"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21395"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2007.01.035"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599813484685","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/0194599813484685","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/0194599813484685","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T09:23:33Z","timestamp":1760952213000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/0194599813484685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,3,27]]},"references-count":11,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2013,6]]}},"alternative-id":["10.1177\/0194599813484685"],"URL":"https:\/\/doi.org\/10.1177\/0194599813484685","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,3,27]]},"assertion":[{"value":"2012-10-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-03-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-03-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}