Laryngeal Botulinum Neurotoxin Injections Improve Work Productivity in Patients with Spasmodic Dysphonia

by Linda Kossoff •

Do employed patients with spasmodic dysphonia experience voice-related work productivity impairment before botulinum neurotoxin (BoNT) injections, and is there an improvement in productivity after BoNT injection treatment?

BOTTOM LINE

Employed patients with spasmodic dysphonia reported voice-related work productivity impairment, which improved significantly one month after treatment with BoNT injection, with that productivity improvement appearing to be greater in women than men.

BACKGROUND: A disordered voice, as is seen in spasmodic dysphonia, can significantly affect work productivity; however, there’s insufficient research evaluating this effect or the potential productivity-related effect of laryngeal BoNT injections on people with the disorder.

COMMENT: This is an article that shows why the larynx matters for everyday things—not just singing or airway protection. It’s about money and valuing the economic contribution and significance of laryngological care. While the paper is about spasmodic dysphonia, it extrapolates to other disorders. —Al L. Merati, MD

STUDY DESIGN: Prospective case series.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, Wash.

SYNOPSIS: From November 2015 to July 2018, researchers recruited patients who had received a diagnosis of spasmodic dysphonia and were scheduled for therapeutic laryngeal BoNT injection appointments at two institutions. Of the 101 enrolled, 75 patients completed the study. At enrollment and one month after BoNT injection, each patient completed the Work Productivity and Activity Impairment test, which uses four measures to quantify the self-reported effect of a disease, the Voice Handicap Index 10, which measures self-perceived voice disability and handicap, the Work Hoarse, specifically developed to address voice disability at work, and a self-reported voice quality rating on a scale of 0% to 100%. They also completed questionnaires of covariate variables at baseline pertaining to demographics, comorbidities, and occupational voice use. Statistical analysis showed a mean improvement of 20% at one month after BoNT injection. Voice-related nonwork activity impairment also showed a statistically significant improvement. Subgroup analysis suggested that women had a worse baseline work productivity impairment than men and experienced a greater improvement than men at one month post-treatment. Study limitations included potential bias from the initial attrition of enrollees, and the absence of a no-treatment group.

CITATION: Meyer TK, Spiekerman C, Kaye R, et al. Association of laryngeal botulinum neurotoxin injection with work productivity for patients with spasmodic dysphonia. JAMA Otolaryngol Head Neck Surg. 2021;147:804-810.