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Effect of Vocal Exercise After Botulinum Toxin Injection for Spasmodic Dysphonia

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ClinicalTrials.gov Identifier: NCT00895063
Recruitment Status : Terminated
First Posted : May 7, 2009
Last Update Posted : March 3, 2016
Sponsor:
Collaborator:
Information provided by (Responsible Party):

Study Description
Brief Summary:
Studies have suggested that voluntary muscle exercise in the hand and face after botulinum toxin injection may enhance the clinical effects of the toxin. Exercise may speed up the absorption of the toxin by the nerves and enhance the clinical response. This study will explore the effect of exercise on botulinum toxin injections for spasmodic dysphonia (SD).

Condition or disease Intervention/treatment
Spasmodic Dysphonia Dystonia Behavioral: Vocal Exercise

Detailed Description:

SD is a rare voice disorder that usually starts when individuals are in early adulthood and occurs in two common forms: adductor and abductor (Aronson, 1968, Brin et al., 1992, Schweinfurth et al., 2002). Adductor is the more common form (Aronson, 1985, Blitzer et al. 1998). With adductor SD, patients have been described as "trying to talk whilst being choked" (Critchley, 1939). The spasmodic hyperadduction of the vocal folds is associated with strained-strangled, rough voice quality and sudden intermittent voice arrests (Aminoff, Dedo, & Izdebski, 1978, Blitzer & Brin, 1992, Hillel, 2001, Izdebski 1992, Ludlow, Nauton, & Bassich, 1984, Woodson, Zwirner, Murry, & Swenson, 1991). On the other hand, the intermittent or continuous abduction of the vocal folds linked with abductor SD results in breathy or whispered voice quality with sudden intermittent voice arrests (Aronson, 1985, Hillel, 2001, and Zwitman, 1979).

Local injection of botulinum toxin is an effective treatment for spasmodic dysphonia and The National Academies of Otolaryngology and Neurology has endorsed the toxin as the treatment of choice for adductor spasmodic dysphonia. Consequently, this treatment is widely used. The clinical benefit of the botulinum toxin is related to muscle weakness in the vocal folds and the benefit lasts from 6 weeks to 6 months.

Studies have suggested that voluntary muscle exercise in the hand and face after botulinum toxin injection may enhance the clinical effects of the toxin (Chen, Scott, & Smith, 2002; Chen et al., 1999; Kim et. al 2003;. Exercise may speed up the absorption of the toxin by the nerves and enhance the clinical response. You are invited to take part in a research study to learn more about the effect of exercise on botulinum toxin injections for spasmodic dysphonic. This project will examine whether or not exercise performed immediately following botulinum toxin injection affects the clinical benefit received from the injection.


Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 8 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Effect of Vocal Exercise After Botulinum Toxin Injection for Spasmodic Dysphonia
Study Start Date : December 2007
Primary Completion Date : May 2013
Study Completion Date : May 2013


Arms and Interventions

Arm Intervention/treatment
Experimental: Vocal Exercise
Subject will speak continually for one hour following injection of botulinum toxin.
Behavioral: Vocal Exercise
This project will examine whether or not exercise performed immediately following botulinum toxin injection affects the clinical benefit received from the injection. This is a cross-over study and subjects will be randomly assigned to a group where they will speak continually for one hour or remain silent for one hour following injection. Data on the effectiveness of the exercise will be collected just before each injection and at 2 weeks, 6 weeks, and 3 months following injection.
Other Names:
  • Botulinum toxin
  • BOTOX
  • BTX
  • BoNT
Placebo Comparator: Silence
Subject will remain silent for one hour following injection of botulinum toxin.
Behavioral: Vocal Exercise
This project will examine whether or not exercise performed immediately following botulinum toxin injection affects the clinical benefit received from the injection. This is a cross-over study and subjects will be randomly assigned to a group where they will speak continually for one hour or remain silent for one hour following injection. Data on the effectiveness of the exercise will be collected just before each injection and at 2 weeks, 6 weeks, and 3 months following injection.
Other Names:
  • Botulinum toxin
  • BOTOX
  • BTX
  • BoNT


Outcome Measures

Primary Outcome Measures :
  1. Self-rating of vocal function [ Time Frame: Baseline, 2 weeks, 6 weeks, 3 months ]

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  1. diagnosis of adductor spasmodic dysphonia
  2. receiving ongoing botulinum toxin injections for a minimum of 1 year
  3. improvement in voice to at least 70% following each of the last three injections

Exclusion Criteria:

  1. other neurological disorder
  2. other dystonia
  3. upper respiratory infection in the last two weeks
  4. analgesia at time of injection
  5. illiterate
  6. under 18 years of age
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00895063


Locations
United States, New York
Private Practice of Dr. Andrew Blitzer
New York, New York, United States, 10036
Sponsors and Collaborators
New York University School of Medicine
Allergan
Investigators
Principal Investigator: Celia F Stewart, Ph.D. New York University
More Information

Responsible Party: New York University School of Medicine
ClinicalTrials.gov Identifier: NCT00895063     History of Changes
Other Study ID Numbers: BOTOXEX
First Posted: May 7, 2009    Key Record Dates
Last Update Posted: March 3, 2016
Last Verified: March 2016

Keywords provided by New York University School of Medicine:
Spasmodic Dysphonia
Botulinum Toxin
Vocal Exercise

Additional relevant MeSH terms:
Dystonia
Dysphonia
Hoarseness
Dyskinesias
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Voice Disorders
Laryngeal Diseases
Respiratory Tract Diseases
Otorhinolaryngologic Diseases
Respiration Disorders
Signs and Symptoms, Respiratory
Botulinum Toxins
Acetylcholine Release Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Cholinergic Agents
Neurotransmitter Agents
Physiological Effects of Drugs