Botulinum Neurotoxin Injections Improve Work Productivity in Employed Adults with Spasmodic Dysphonia

by Linda Kossoff •

To what extent are laryngeal botulinum neurotoxin (BoNT) injections for employed patients with spasmodic dysphonia associated with changes in these patients’ work productivity?

BOTTOM LINE

Patients who received BoNT injections into the intrinsic laryngeal musculature reported a significant improvement in voice-related work productivity and nonwork activity impairment.

BACKGROUND: Voice disorders such as spasmodic dysphonia can affect an individual’s work- and non-work-related life. Currently, there is insufficient research on the effect of spasmodic dysphonia, or its treatment with BoNT injections, on work productivity. The Work Productivity and Activity Impairment (WPAI) tool is used to measure dysphonia-related absenteeism and presenteeism.

COMMENT: This case series study found that employed patients with spasmodic dysphonia reported voice-related work productivity impairment, which improved significantly one month after treatment with BoNT injection, emphasizing the critical role that voice plays in everyday life. As this relates to work productivity, there’s a clear connection to the monetary impact of voice disorders and, subsequently, the economic significance of laryngological care. While the paper is about spasmodic dysphonia, the implications extend to other voice disorders. —Albert L. Merati, MD

STUDY DESIGN: Prospective case series.

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

SYNOPSIS: Researchers sought to assess whether employed patients with spasmodic dysphonia experienced voice-related work productivity impairment before BoNT injection, and whether they had a 10% or greater improvement in productivity one month after treatment. The series was conducted in two laryngology outpatient clinics from November 2015 to August 2018. Enrolled patients completed the following outcome instruments at enrollment and at one month after BoNT injection into the intrinsic laryngeal musculature: Work Productivity and Activity Impairment (WPAI) instrument, Voice Handicap Index 10 (VHI), WorkHoarse, and self-reported rating on voice quality. Most participants reported high occupational voice use. A total of 75 employed adult patients completed the study. Among these participants, work productivity impairment was improved by a mean of 20% and voice-related nonwork activity impairment showed a statistically significant improvement at one month after BoNT. Data also indicated that women had a larger magnitude baseline deficit in work productivity than men and, therefore, greater improvement after BoNT injections, but this finding requires independent validation. Limitations included the enrollee attrition, which might have biased the results, and the fact that results are self-reported without an objective standard.

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.