Posted by: David Barton ®
12/18/2006, 16:15:38
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Yes, although it was a long time ago. This was what happened after very low dose bilateral shots (these days I get unilateral high dose). My vocal cords were sensitive to the Botox so it worked, with breathiness, but the dose was not sufficient to last long so the SD kicked back in. The doctors had gradually worked the dose downwards to 0.33 from about 2.5 to avoid the extreme breathiness. Following advice from Dr Christy Ludlow, for which I will always be grateful, we switched over to unilateral shots a while ago. These have been very successful in my case - lasting longer and without the extreme aphonia I experienced with some of the earlier shots.David Barton (AD/SD, North Shore, New Zealand)
Modified by David Barton at Mon, Dec 18, 2006, 21:54:39
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Posted by: NWallin ®
12/19/2006, 07:39:52
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David,
Just curious, how long have you been receiving Botox? And how long can you expect your unilateral dose to last? I am interested in trying this approach. Nicole
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Posted by: David Barton ®
12/19/2006, 14:34:39
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Hi NicoleI have been having Botox shots for my SD since 1991 - so over 15 years. A total of 47 injections altogether. The longest period between shots has been 8 months. My doctors and I adjusted the dose down from 10 units to 8 units recently and I am expecting the interval between shots to be about 6 months this time. If you want to read more about unilateral Botox injections then there is plenty both in the archives (link at top of BB), or use the 'Find' button on the main page of the BB, and also I wrote more about my experience here: http://www.dysphonia-bb.org/forums/sd/posts/29433.html Opting for unilateral shots instead of bilateral isn't for everyone (many get good results from lowish dose bilateral) but it is worth trying if you experience severe breathiness in the weeks after bilateral shots. Good luck David Barton (AD/SD, North Shore, New Zealand)
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Posted by: nan g ®
12/19/2006, 08:14:05
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I had the same experience with my first round of botox, had the breathy voice for weeks, but as the botox wore off my voice was just as it was before, very strained, spasming all over the place. I had 2.5 bilaterally into the TA muscles (standard protocol). It was disappointing to say the least. With the second go round my doctor tried a different approach and injected into a different muscle of the larynx. I had a much better result. I've done some research and it turns out that different/multiple muscles of the larynx can be involved with SD and this explains some botox failures. Good luck. Nan (AD/SD)
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Posted by: mdubovick ®
12/25/2006, 16:00:34
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Nan, two follow up questions, please:
1. Do you have AD/SD?
2. Could you please ask your ENT precisely what muscle was injected so I can discuss it with my doctor?Much Thanks; If you wish to write to me offline, my userid is:
meldubovick@comcast.net
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Posted by: nan g ®
12/26/2006, 11:35:18
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Mel,Happy to answer your questions. 1) Yes, I do have AD/SD. 2) The predominant muscle is my case is the interarytenoid muscle. I know this because my doctor performed an EMG (electromyography) to identify which muscles were involved. It turns out that multiple muscles are involved, the interarytenoid and TA muscles. On my last round I had 5.0 units injected into the interarytenoid muscle and 1.25 injected into each TA muscle. I had very good results but a long breathy phase (probably 3 weeks) and I started to spasm again after about a month of near perfect voice. I am still experimenting with dosing. I have my fourth round of botox in under an hour (better get going actually) and I am going to request a smaller dose. I would rather have more frequent shots and shorter breathy periods. I'm keeping my fingers crossed that I still see a good result with the smaller dose. Also, hope my new insurance company will comply with my wishes. I am pasting an abstract that I found helpful. It's intended for a medical audience but by now most of us are probably far more versed in this jargon than we ever thought we'd be. * Klotz DA,
* Maronian NC,
* Waugh PF,
* Shahinfar A,
* Robinson L,
* Hillel AD.
Although perceptual and stroboscopic data help in diagnosing and classifying laryngeal dystonia, these measures do not aid the voice clinician in targeting which specific muscles to treat with botulinum toxin. Most patients achieve smoother, less effortful voicing with standard injection regimens. However, there is a notable failure rate. We performed fine-wire electromyography on 214 consecutive patients with laryngeal dystonia. We correlated voice ratings, stroboscopy data, and fine-wire electromyography data. Videostroboscopy was successful in visually demonstrating most of the audible findings in isolated vocal tremor, but it was much less successful in identifying breaks alone or a combination of breaks and tremor. Fine-wire electromyography revealed that the thyroarytenoid muscle was significantly more likely than the lateral cricoarytenoid muscle to be the predominant muscle associated with adductor spasmodic dysphonia, and that the thyroarytenoid and lateral cricoarytenoid muscles were equally likely to be predominantly involved in tremor spasmodic dysphonia. In addition, several patients in both the adductor spasmodic dysphonia and the tremor spasmodic dysphonia groups presented with interarytenoid muscle predominance. All of the intrinsic laryngeal muscles are capable of being the predominant muscle in laryngeal dystonia, and there are patterns of muscle abnormalities that differ between adductor spasmodic dysphonia and tremor spasmodic dysphonia. Some of the failures in treating adductor spasmodic dysphonia with botulinum toxin, and the greater difficulty with success in treating patients with tremor spasmodic dysphonia, are due to failure to deliver toxin to the appropriate muscles.
Good luck with your next round of botox. I hope you see a much better outcome. Nan (AD/SD)
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Posted by: narelle ®
12/19/2006, 22:20:12
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HI,I had this the whole time with my botox treatment - although when I got up to 15 units bilaterally I once got 6 weeks - still breathy all the way though! The first conclusion was that it was because I was young and my muscles were not weak at all and bounced back alot quicker than the mostly older patients who were having botox where i live. (I have had AD/SD since 17, but didn't get botox until 25) The doctors came to the conclusion, after trying varying doses over a 5 year period, and unilateral vs bilateral, and different "strains" of botox, that I was basically immune to the stuff. I made alot of phone calls during the "breathy' stage! Hopefully they just need to up your dose - as they obviously hit the right spot - hence the breathiness. Cheers Narelle, Australia
AD/SD 20 years, successful Thyroplasty Type II 2000.
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