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<p>Bilateral Vocal Fold Paralysis (BVFP) is a rare, potentially life-threatening condition affecting all age groups and involving impaired movement of both vocal cords, leading to airway obstruction. Although botulinum toxin injection is an emerging, minimally invasive treatment option for improving the airway in BVFP, its clinical use remains limited. Thus, this systematic review and meta-analysis aims to assess the efficacy, safety, and functional outcomes of botulinum toxin in BVFP. A systematic search for studies (from 1998 to November 2025) on the use of botulinum toxin injection for bilateral vocal fold paralysis was conducted across PubMed, Embase, Scopus, and Google Scholar. Study selection, data extraction, and quality assessment were performed independently by multiple reviewers. Quality assessment was conducted using standardized tools (NIH, JBI, and ROBINS-I V2). A single-arm meta-analysis of pooled improvement proportions was conducted using a random-effects model in R, and subgroup analysis was made between two injection sites: TA and CT. A total of 9 studies were included, comprising 79 patients with bilateral vocal fold paralysis. Most studies were retrospective case series with an overall fair to moderate risk of bias. Botulinum toxin type A was used in all studies, most commonly into the thyroarytenoid or cricothyroid muscles. Overall, 91% of patients showed clinical improvement following botulinum toxin injection (pooled proportion 0.91; 95% CI 0.72–1.00) with moderate heterogeneity (I<sup>2</sup> = 63.6%). Improvement rates were 84% (95% CI 0.51–1.00) for the thyroarytenoid group and 97% (95% CI 0.851.00) for the cricothyroid group. However, this difference was not statistically significant. Reported adverse effects were mild and transient.Botulinum toxin injection appears to be a safe and effective temporary or bridging therapy for improving airway outcomes in bilateral vocal fold paralysis while preserving voice and swallowing function. Further high-quality prospective studies are needed to define optimal dosing, injection targets, and patient selection.</p>

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Botulinum Toxin for Bilateral Vocal Fold Paralysis: A Systematic Review and Meta-Analysis of Efficacy, Safety, and Functional Outcomes

  • 期刊论文

  • 发表日期：

    2026年5月11日

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  • Bigyan Gyawali,
  • Prana Joshi,
  • Siddhartha Karn,
  • Sasmit Ghimire,
  • Shivam Jha,
  • Sujan Sunar

摘要

Bilateral Vocal Fold Paralysis (BVFP) is a rare, potentially life-threatening condition affecting all age groups and involving impaired movement of both vocal cords, leading to airway obstruction. Although botulinum toxin injection is an emerging, minimally invasive treatment option for improving the airway in BVFP, its clinical use remains limited. Thus, this systematic review and meta-analysis aims to assess the efficacy, safety, and functional outcomes of botulinum toxin in BVFP. A systematic search for studies (from 1998 to November 2025) on the use of botulinum toxin injection for bilateral vocal fold paralysis was conducted across PubMed, Embase, Scopus, and Google Scholar. Study selection, data extraction, and quality assessment were performed independently by multiple reviewers. Quality assessment was conducted using standardized tools (NIH, JBI, and ROBINS-I V2). A single-arm meta-analysis of pooled improvement proportions was conducted using a random-effects model in R, and subgroup analysis was made between two injection sites: TA and CT. A total of 9 studies were included, comprising 79 patients with bilateral vocal fold paralysis. Most studies were retrospective case series with an overall fair to moderate risk of bias. Botulinum toxin type A was used in all studies, most commonly into the thyroarytenoid or cricothyroid muscles. Overall, 91% of patients showed clinical improvement following botulinum toxin injection (pooled proportion 0.91; 95% CI 0.72–1.00) with moderate heterogeneity (I2 = 63.6%). Improvement rates were 84% (95% CI 0.51–1.00) for the thyroarytenoid group and 97% (95% CI 0.851.00) for the cricothyroid group. However, this difference was not statistically significant. Reported adverse effects were mild and transient.Botulinum toxin injection appears to be a safe and effective temporary or bridging therapy for improving airway outcomes in bilateral vocal fold paralysis while preserving voice and swallowing function. Further high-quality prospective studies are needed to define optimal dosing, injection targets, and patient selection.