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Spasmodic Dysphonia & Botulinum Toxin

Updated: Nov 14, 2023

As an ENT surgeon, I have treated many patients with spasmodic dysphonia, a neurological disorder that causes involuntary spasms in the muscles of the voice box, resulting in voice tremors and difficulty speaking. While there are several treatment options available for this condition, I often recommend botulinum toxin injections as an effective treatment for my patients.


Botulinum toxin, commonly known as Botox, is a purified protein that works by blocking the signals from nerves to muscles, thereby relaxing the muscles and reducing spasms. It is widely used in cosmetic procedures, but it also has therapeutic applications, including treating spasmodic dysphonia.


To administer Botox for spasmodic dysphonia, I use a small needle to inject the toxin directly into the affected muscles of the larynx, or voice box. The procedure takes only a few minutes and can be done in the clinic, without the need for anesthesia. Patients usually experience relief within a few days of the injection, with the effects lasting for several months.


While Botox injections are generally safe, there are some potential side effects, such as hoarseness, difficulty swallowing, or breathing problems. However, these side effects are usually temporary and can be managed with proper care.


It is important to note that Botox injections are not a cure for spasmodic dysphonia, but rather a treatment that needs to be repeated periodically. Nevertheless, they can provide significant relief from the symptoms of the condition, allowing patients to speak more easily and with less effort.


I remember a patient who was referred to me by their primary care physician for the treatment of spasmodic dysphonia. The patient, a 55-year-old female, had been experiencing voice tremors and a strained, hoarse voice for several months, which was affecting her ability to communicate and causing her considerable distress.

Upon examination, I confirmed the diagnosis of spasmodic dysphonia, a condition in which the muscles of the vocal cords involuntarily contract and cause voice tremors or a strained, hoarse voice. The patient had already undergone speech therapy, which had not provided significant relief from her symptoms.

I discussed treatment options with the patient, and we decided to proceed with botulinum toxin injections into the affected vocal cord muscles to relax them and improve her voice quality. I explained the procedure and its potential side effects, which include temporary voice weakness or breathlessness, and the patient provided informed consent.


I performed the injections in my clinic under local anesthesia, using a thin needle to inject a small amount of botulinum toxin directly into the affected muscles of the vocal cords. The patient tolerated the procedure well, and I provided her with post-injection care instructions.


The patient returned for follow-up appointments every three months, as this is the typical duration of effect of botulinum toxin injections. At each visit, I assessed her symptoms and voice quality, and adjusted the dose and injection technique as needed to optimize the outcome.


I am happy to report that the patient experienced significant improvement in her voice quality and ability to communicate following the botulinum toxin injections. She was very pleased with the results and continues to return for regular injections to maintain the effect.


In conclusion, botulinum toxin injections are a safe and effective treatment option for patients with spasmodic dysphonia. As an ENT surgeon, I have seen the benefits of this treatment firsthand, and I am pleased to offer it to my patients. If you or someone you know is struggling with spasmodic dysphonia, I encourage you to speak with your healthcare provider about whether Botox injections may be an appropriate treatment option.


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