Treatment of speech and voice disorders with botulinum toxin

Article Abstract:

The case history of a 37-year-old female patient with a voice disorder is presented. Shortly after an upper respiratory infection, the patient began to have difficulty controlling her voice. Her speech was interrupted by pitch and voice breaks, and speech therapy was not effective. The symptoms progressed and, because no cause could be identified and the patient was undergoing considerable personal stress, psychological counseling was recommended. In the ensuing years, the patient changed jobs, and sought treatment with hypnosis, acupuncture, and medications. Examination at the National Institutes of Health led to the injection of botulinum toxin into the thyroarytenoid muscles (one set of muscles that controls the vocal cords). The patient's diagnosis was spasmodic dysphonia (SD), a condition of spasticity of certain muscles that control the vocal cords. Descriptions of this disorder, which begins spontaneously, and its underlying physiology are presented. Botulinum toxin, injected into the muscle fibers, makes the fibers inactive for several months; repeat injections are needed after new fibers grow. This treatment produced clinical benefit for all but 2 of 120 SD patients. In addition, botulinum toxin injected into the laryngeal muscles of stutterers led to less disrupted speech. However, only four of seven patients returned for repeat injections, and most of these did not want further injections. Some objected to the breathy voices they developed for the first few weeks after injection. The method works by reducing the abnormally high levels of muscle activation in SD and stuttering. (Consumer Summary produced by Reliance Medical Information, Inc.)

Stuttering, Voice disorders

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Fish botulism - Hawaii, 1990

Article Abstract:

Three adults in Hawaii were hospitalized with botulism after eating a palani fish bought at the local fish market. The palani is a reef scavenger fish eaten by local residents. The fish intestines had not been thoroughly removed, and had been eaten by two of the affected patients, while the third ate meat near the head and tail. A fourth person ate only meat from the back of the fish, and did not get sick. Foodborne botulism is caused by Clostridium botulinum, usually associated with home-canned and preserved products. It causes muscle paralysis beginning with the upper body and progressing downward, paralyzing the chest muscles and compromising breathing. The antitoxin prevents progression of the paralysis, and clinicians should not wait for laboratory confirmation before giving the antitoxin when botulism is suspected. This is the first report in the United States of botulism caused by fresh fish. It is also unusual because it was caused by type B C. botulinum, not the more common type E. Certain ethnic foods make use of ungutted fish, and may be rare sources of botulism. Local cultural practices should be taken into account by public health departments. Quick action by state health departments when botulism is suspected may prevent additional cases, and lead to faster administration of the antitoxin to affected persons. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Fish as food, Fish (Food product), Hawaii, Contamination

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Botulism in 4 adults following cosmetic injections with an unlicensed, highly concentrated botulinum preparation

Article Abstract:

The clinical, epidemiological, and laboratory aspects of four suspected cases of iatrogenic botulinum are investigated. Clinical characteristics of the four case-patients are consistent with those of naturally occurring botulism, and these cases also demonstrate that clinical use of unlicensed botulinum toxin A can result in severe, life threatening illness.

Usage, Diagnosis, Clinical report

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