Various disorders in the ear, nose, and throat (ENT) field are suited for treatment with botulinum toxin (BoNT). They can be divided into two general groups:

1. Disorders concerning head and neck muscles (movement disorders)

2. Disorders caused by a pathological secretion of glands located in the head and neck region.

Table 12.1 summarizes the diseases relevant to otolaryngology. The focus in this chapter lies on indications that are not reviewed in other chapters. Thus, laryngeal dystonia, hemifacial spasm, blepharospasm, and synkinesis following defective healing of the facial nerve will not be covered here.

Dysphagia and speech problems following laryngectomy

Some patients are unable to achieve an adequate speech level for optimal communication after laryngectomy. One of the causes is spasms of the cricopharyngeal muscle. In this condition BoNT can reduce the muscle activity and improve the quality of speech (Chao et al., 2004). Swallowing disorders in neurological patients can result from a disturbed coordination of the relaxation of the upper esophageal sphincter (UES) and can lead to pulmonary aspiration. The cricopharyngeal muscle is a sphincter between the inferior constrictor muscle and the cervical esophagus and is primarily innervated by the vagus nerve.

Twenty (mouse) units of Botox® (100 units of Dyport®; 1000 units of NeuroBloc®/Myobloc® [BoNT-B]; [conversion factors seeTable 12.2]) were injected into each of three injection points under general anesthesia (Figure 12.1). This procedure can be used as a test prior to a planned myectomy or as a single therapeutic option that has to be repeated.