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portant to acknowledge, however, that this group of par-
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ticipants was a small sample size of only 10 respondents
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From these participants, cannabinoid products were felt to
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play a different role in treating their dystonia
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Further
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investigation is required to determine if patients using
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cannabinoids exclusively for their vocal dystonia are able
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to do so due to less severe symptoms at baseline relative to
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other patients
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In a survey of 496 patients conducted by
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Pandey et al
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(2019), over 50% of the respondents reported
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improvements in their dystonia symptoms after using
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medical cannabis.17 The most common benefits reported
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were reduced pain, improved sleep, and reduced anxiety
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In this study, cannabinoids were felt to be useful in
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managing acute symptoms with immediate impact, while
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BTX was more effective longitudinally managing their
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dystonia
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In this way, cannabinoids were helpful managing
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symptoms in the period between BTX injections and
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FIGURE 8
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Table displaying descriptive responses from participants about their perspectives on the role of cannabinoids in treating
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vocal dystonia
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Noah Millman, et al Cannabinoid Use in the Treatment of Laryngeal Dystonia 7
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Downloaded for Anonymous User (n/a) at McMaster University from ClinicalKey.com by Elsevier on September 08,
|
2023
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For personal use only
|
No other uses without permission
|
Copyright ©2023
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Elsevier Inc
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All rights reserved
|
elongated the time interval between injections
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Future
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studies would be helpful in further exploring the sub-
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jectively increased time intervals between BTX injections
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as well as further investigating the effects of varying can-
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nabinoid dosages on perceived efficacy
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Although it is uncertain if cannabinoids play a direct role
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in addressing the physiological cause of laryngeal dystonia/
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vocal tremor/MTD, participants often reported an indirect
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benefit in using cannabinoid products as these products
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helped relieve the stress and anxiety that frequently ex-
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acerbate their vocal condition
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LIMITATIONS
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As an electronic survey, this study is limited to participants
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who have Internet access
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The electronic link was dis-
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tributed exclusively through the Dystonia International
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(previously National Spasmodic Dysphonia Association)
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listserv, limiting the diversity of the sample population
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The
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intrinsic nature of online surveys can also predispose to
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self-selection bias as participants choose to participate in
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the survey potentially based on pre-existing bias
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Patients
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with a positive response to cannabinoids may have been
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more likely to respond, while those who had never con-
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sidered cannabinoids may have not had as pronounced
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interest in responding
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This may be reflected in the low
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percentage response rate, with only 158 responses in a
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collection of 5000 total emails in the listserv
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However, it
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would be inaccurate to attribute the low response rate to
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selection bias alone, as the listserv was comprised of not
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just patients, but also physicians and healthcare profes -
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sionals
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Without knowing the exact number of patients in
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the listserv, the true response rate is difficult to calculate
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As this study required participants to retrospectively recall
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the extent of effectiveness after using cannabinoid pro-
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ducts, there is likely recall bias that is affecting the col-
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lected data
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CONCLUSION
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A considerable number of patients with vocal dystonia
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have tried using cannabinoid products or currently use
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cannabinoids to treat their laryngeal dystonia, vocal
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tremor, and MTD
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Most participants considered cannabi -
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noids as either less effective or similarly effective to other
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treatments in treating their vocal dystonia
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A select group
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of participants who used cannabinoids with Botox injec -
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tions reported the combination as more effective than using
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Botox alone
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A prospective study is warranted for further
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investigation to help clinicians counsel patients in their
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treatment journey
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Appendix A
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Supporting information
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Supplementary data associated with this article can be found
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in the online version at doi:10.1016/j.jvoice.2023.05.006
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REFERENCES
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1.Cannito MP, Johnson JP
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Spastic dysphonia: a continuum disorder
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J
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Commun Disord
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1981;14:215–233
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https://doi.org/10.1016/0021-9924(81)
|
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