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Sean Parker Institute for the Voice

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Injection Augmentation Offers No Advantage Over Botulinum Toxin Chemodenervation to Patients with Essential Voice Tremor

An Institute study published in The Laryngoscope showed no clear benefit from injection augmentation over traditional botulinum toxin treatment in a small group of patients essential voice tremor. Botulinum toxin chemodenervation is often less than satisfactory in the symptomatic treatment of voice tremor because of severe breathiness. The period of benefit which follows may be no longer than the period of breathy, low voice after injection, and in some cases, even shorter. Since injection augmentation is used to treat conditions in which the vocal folds do not meet during voicing, which is the cause of the breathiness, investigators wanted to assess the technique in the context of voice tremor. Patients were intially treated with botulinum toxin, then once that had run its course, with injection augmentation. The outcomes at 1 month were compared. Injection augmentation yielded no greater benefit, and in some cases less, than botulinum toxin. Study conclusions are limited by the small number of subjects, but for the moment, botulinum toxin remains the preferred injectable treatment for this disorder, despite its limitations. 

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