声门上肉毒杆菌毒素注射改善喉部感觉功能障碍的症状

文献信息

中文摘要

目的： 中枢/外周迷走神经超敏反应是喉部感觉功能障碍（LSD）的基础。A型肉毒杆菌毒素（BoNT-A）注射已成为调节喉部感觉通路的靶向治疗方法。本研究旨在评估难治性LSD患者接受声门上BoNT-A注射后的短期结局及反应预测因素。
方法： 对2019年至2025年间因药物治疗/行为治疗难治性LSD症状而接受声门上BoNT-A注射治疗的患者进行回顾性队列研究。结局指标包括纽卡斯尔喉部超敏反应问卷（LHQ）、反流症状指数（RSI）、咳嗽严重程度指数（CSI）和嗓音障碍指数-10（VHI-10）。使用配对统计检验和效应量估计比较治疗前后评分。报告治疗特征和随访持续时间，以及最小临床重要差异（MCID）的达成情况和反应预测因素。
结果： 80例连续患者（平均年龄58.3岁；48例女性）在超敏反应领域显示出显著改善：LHQ +3.1（95% CI：2.4-3.8，p < 0.001），RSI -7.9分（95% CI：-9.7至-5.8，p < 0.001），CSI -5.7分（p < 0.001）。VHI-10无变化（-1.3，p = 0.20）。LHQ的MCID阈值达成率为64%，RSI为56%。总体而言，71%的患者报告了表型和临床相关改善。短期喉上神经（SLN）阻滞阳性的患者更可能对声门上BoNT产生反应。未发生严重并发症。
结论： 声门上BoNT-A注射是治疗喉部感觉功能障碍的一种安全、有效的方法，其靶向SLN的感觉区域，可在不损害嗓音功能的情况下提供临床上有意义的咽喉刺激减少。

英文摘要

OBJECTIVE: Central/peripheral vagal hypersensitivity underpins laryngeal sensory dysfunction (LSD). Botulinum toxin type A (BoNT-A) injection has emerged as a targeted treatment for modulating laryngeal sensory pathways. This study aimed to evaluate short-term outcomes and predictors of response following supraglottic BoNT-A injection in patients with refractory LSD.
METHODS: Retrospective cohort study of patients undergoing supraglottic BoNT-A injection treatment between 2019 and 2025 for LSD symptoms refractory to medical/behavioral therapy. Outcome measures included the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ), Reflux Symptom Index (RSI), Cough Severity Index (CSI), and Voice Handicap Index-10 (VHI-10). Pre- and post-treatment scores were compared using paired statistical tests and effect size estimation. Treatment characteristics and follow-up duration were reported, along with attainment of minimal clinically important difference (MCID) and predictors of response.
RESULTS: Eighty consecutive patients (mean age 58.3 years; 48 female) showed significant improvement across hypersensitivity domains: LHQ +3.1 (95% CI: 2.4-3.8, p < 0.001), RSI -7.9 points (95% CI: -9.7 to -5.8, p < 0.001), CSI -5.7 points (p < 0.001). VHI-10 was unchanged (-1.3, p = 0.20). MCID thresholds were achieved in 64% for LHQ and 56% for RSI. Overall, 71% of patients reported phenotypic and clinically relevant improvement. Patients with a positive short-term superior laryngeal nerve (SLN) block were more likely to respond to supraglottic BoNT. No serious complications occurred.
CONCLUSIONS: Supraglottic BoNT-A injection is a safe, effective treatment for laryngeal sensory dysfunction targeting the sensory field of the SLN to provide clinically meaningful reductions in throat irritation without compromising voice function.