Evidence map›Paper›PMID 42472925›Full record

Observational studyEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026

Awake transoral intralaryngeal botulinum toxin injection for early bilateral vocal fold immobility: a five-year experience.

Reham Abdelwakil Ibrahim, Mohamed Mahmoud Mohamed Roushdy, Shereen Farghaly, Mohamed Modather Aboshanif

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Awake transoral intralaryngeal botulinum toxin injection for early bilateral vocal fold immobility: a five-year experience.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026
    Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Reham Abdelwakil IbrahimPhoniatrics Unit, Otorhinolaryngology Department, Faculty of Medicine, Assiut University, Assuit, 71515, Egypt. dr.reham.ibrahim@gmail.com.ORCID http://orcid.org/0000-0003-4850-1501
Mohamed Mahmoud Mohamed RoushdyOtorhinolaryngology Department, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
Shereen FarghalyDepartment of Chest Diseases, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
Mohamed Modather AboshanifOtorhinolaryngology Department, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo describe a single-centre clinical experience with awake intra-laryngeal botulinum toxin type A (BTXA) injection in adults with early-onset bilateral vocal fold immobility (BVFI), and to report temporal clinical observations associated with a staged bilateral injection protocol.

methodsThis retrospective observational study included 47 adult non-tracheostomized patients with early BVFI treated between January 2020 and March 2025. All patients underwent awake trans-oral BTXA injection under indirect laryngoscopic visualization (5 U per vocal fold). Bilateral treatment was performed using staged unilateral injections administered 24 h apart. Peak inspiratory flow (PIF) and Dyspnea Index (DI), voice and swallowing outcomes were assessed before injection and during follow-ups.

resultsImprovement in airway-related measures was observed during follow-up. Median DI decreased after injection and median PIF increased during the expected pharmacological window of BTXA activity, with partial symptom recurrence by four months. Clinical improvement followed the known delayed pharmacodynamic profile of BTXA, with onset occurring after several days and peak effect within the first two weeks. Two patients required temporary tracheostomy and were subsequently decannulated. Voice and swallowing function remained largely preserved.

conclusionsAwake intra-laryngeal BTXA injection was feasible as a reversible temporizing intervention for selected patients with early bilateral vocal fold immobility during the observation period. The staged bilateral injection strategy is presented as an experience-based technical approach that might help avoid tracheostomy in selected patients; however, a 24-hour interval between injections didn't appear to produce a clearly distinct staged pharmacodynamic effect. Findings should be interpreted as descriptive clinical observations requiring prospective validation. LEVEL OF EVIDENCE: 4:

Indexed as

Botulinum Toxins, Type ANeuromuscular AgentsVocal Cord ParalysisAdultAgedFemaleHumansInjections, IntralesionalLaryngoscopyMaleMiddle AgedRetrospective StudiesTreatment OutcomeWakefulnessBotulinum Toxins, Type ANeuromuscular AgentsAirway obstructionBilateral vocal fold immobilityBotulinum toxin AStaged injectionTracheostomy avoidance

Identifiers

PMID42472925
PMCPMC13615057

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.