Botulinum toxin in the treatment of sialorrhea.

BACKGROUND/AIM: Botulinum toxin-A (BTX-A) is known to block the release of acetylcholine from motor and autonomic nerve terminals and may significantly decrease saliva production when injected intraglandulary. The aim of this study was to evaluate effects of BTX-A injections in the treatment of disabling sialorrhea in various neurological disorders. METHODS: This study included 19 consecutive patients with significant sialorrhea associated with various neurological disorders. Out of them 13 patients were with Parkinson's disease, two with pantothenate kinase-associated neurodegeneration, two with multiple system atrophy, one with Wilson's disease, and one patient with postoperative sialorrhea. Botulinum toxin-A (Dysport, Ipsen Pharma) was injected into the parotid glands with (n=7 patients) or without (n=12 patients) ultrasound guidance. All the patients were scored before and after the treatment and in weekly intervals thereafter using the salivation item of the part II (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS: Thirteen patients (68%) reported beneficial effect of BTX-A injection, while 6 of them (32%) had no response at all The sialorrhea scores before and after the treatment were 3.1 +/- 0.1 (range 2-4) and 1.8 +/- 0.1 (range 0-3), respectively (t=5.636; p<0.001). There was no difference in the magnitude of response between the groups with (t=4.500; p=0.004) and without (t=3.674; p=0.005) ultrasound control of injection sites. Adverse effects were registered in 5 patients (26%). CONCLUSIONS: Botulinum toxin-A injections to easily accessible parotid glands, without necessity for ultrasound guidance, are safe and efficaceous treatment for sialorrhea in different neurological disorders.

[Botulinum toxin efficacy in the treatment of patients with spasmodic dysphonia].

BACKGROUND/AIM: Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80-100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. METHODS: The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12-16 units each. In our study we applied indirect technique originally developed by Hocevar and Pirtosek. Perceptive voice and speech analysis was performed prior to and after the instillation of botuline toxin as per structured Scale of pathological characteristics of voice and speech appearing in the spasmodic dysphonia. RESULTS: The majority of our patients experienced both subjective improvement and the improvement in the terms of the quality of life, Voice Henolicap Index--(VHI) that was rated as rather significant one (t = 3.562; p = 0.006). CONCLUSION: Regardless unquestionable improvement of definite phonation, further function restitution requires individual vocal therapy and psychotherapy. Vocal therapy includes structural vocal techniques which reduce degree of vocal tension and rapid changes in the power and the height of voice. Further investigations are necessary for the scope of the definition of a standardized therapeutically procedure for spasmodic dysphonia treatment which comprises multidisciplinary approach in diagnosis, therapy and treatment efficacy evaluation.

[Pathologic conditions associated with drug-induced rhinitis]. / Patoloska stanja udruzena s medikamentnim rinitisom.

Rhinitis medicamentosa ("nose-drop-nose") is a term used for pathological condition of the nasal mucous membrane that results from long-term abuse with intranasal vasoconstrictors. The aim of this work was to examine what lead the patients with nosedropnose rhinitis to the initial usage of intranasal vasoactive drugs. In this prospective study, 92 patients with rhinitis medicamentosa were included. The evaluation of all study subjects comprised the history, ORL, microbiological and radiological examination, skin prick tests with a battery of routine respiratory and nutritive allergens and nasal cytology. The results of this study showed that the pathological conditions for initial use of intranasal vasoactive drugs were: acute upper respiratory infections in 29.3%, vasomotor rhinitis in 21.7%, allergic rhinitis in 16.3%, deviated nasal septum in 13.0%, nasal polyposis in 12%, rhinitis induced by mechanical trauma in 4.4%, and hormonal rhinitis in 3.3% of patients with rhinitis medicamentosa. In conclusion, the most common pathological conditions for developing rhinitis medicamentosa were chronic inflammatory and structural diseases manifested by permanent nasal obstruction as well as acute upper respiratory infections are.