THE IMPACT OF BOTULINUM TOXIN ON VOICE QUALITY AFTER LARYNGECTOMY

Natalia Hariasz; Paulina Malon; Karol Śliwa; Anita Pieńkowska; Aleksandra Trojańska; Nel Geworkian; Martyna Pietz; Anita Szymańska

doi:10.31435/ijitss.1(49).2026.4804

Authors

Natalia Hariasz 4th Military Clinical Hospital in Wroclaw, Wrocław, Poland https://orcid.org/0009-0000-5397-0324
Paulina Malon Collegium Medicum Nicolaus Copernicus University, Poland https://orcid.org/0009-0008-9311-001X
Karol Śliwa University of Warmia and Mazury in Olsztyn, Collegium Medicum, Olsztyn, Poland https://orcid.org/0009-0006-4181-9778
Anita Pieńkowska Independent Physician, Białystok, Poland https://orcid.org/0009-0008-9903-007X
Aleksandra Trojańska University Clinical Hospital in Poznań, Poznań, Poland https://orcid.org/0009-0005-9659-875X
Nel Geworkian University Clinical Hospital in Poznań, Poznań, Poland https://orcid.org/0009-0008-2248-6052
Martyna Pietz University Clinical Hospital in Poznań, Poznań, Poland https://orcid.org/0009-0003-7628-9517
Anita Szymańska University Clinical Hospital in Poznań, Poznań, Poland https://orcid.org/0009-0005-9762-3347

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4804

Keywords:

Tracheoesophageal Speech, Total Laryngectomy, Pharyngoesophageal Segment, Botulinum Toxin, Voice Rehabilitation

Abstract

Objectives: Tracheoesophageal (TE) speech is the preferred method of voice rehabilitation after total laryngectomy; however, its effectiveness is frequently compromised by pharyngoesophageal spasm (PES). The objective of this review was to evaluate the anatomical, physiological, diagnostic, and therapeutic evidence supporting the use of botulinum toxin (BTX) for the management of PES-related TE voice dysfunction.

Methods: A narrative review of peer-reviewed English-language literature was conducted using PubMed and major scientific databases. Studies addressing pharyngoesophageal segment physiology, diagnostic assessment of PES, and clinical, acoustic, aerodynamic, and perceptual outcomes following BTX injection in laryngectomized patients were qualitatively synthesized.

Results: Across heterogeneous study designs, PES was consistently identified as a primary barrier to effective TE phonation, characterized by elevated intraluminal pressure, restricted segmental aperture, and impaired vibratory behavior. BTX injection reliably reduced PE segment hypertonicity, resulting in improved airflow dynamics, enhanced vibratory regularity, increased maximum phonation time, and improved acoustic stability. Perceptual assessments and patient-reported outcomes demonstrated significant gains in speech intelligibility, vocal effort, communicative participation, and quality of life. Additional benefits included improved prosthesis function and longevity. Adverse effects were mild, transient, and infrequent.

Conclusions: Botulinum toxin is a safe, minimally invasive, and physiologically targeted treatment for PES-related TE speech dysfunction. The convergent evidence supports its role as a first-line or adjunctive therapy for restoring voice quality and communication after total laryngectomy.

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