Botox Injection for Spasmodic Dysphonia Surgery Instructions

Spasmodic dysphonia is a voice disorder that results in a strangling sensation when speaking and voice stoppages (AD or adductor type), or breathiness or loss of control of voice volume during speaking (AB or abductor type). In many patients, injection with Botox is recommended to treat the disorder.

The Botox procedure is performed at specified times that will be arranged on monthly to six-week intervals. If you are on the Botox list, you will likely be called and advised of the next Botox date.

The Botox injection procedure is performed as a collaboration between Otolaryngology and Neurology. On the day of your injection, you will check in at the ENT clinic, and then be taken to the Neurology clinic.

For the AD spasmodic dysphonia, you will be asked to lay on your back with your head extended. This will allow the surgeon to feel the landmarks of your voice box.

A small injection and localization needle is then used to locate the specific muscles that seem to be overactive. In most cases, this is the vocalis muscle. Once the vocalis muscle is located, a small amount of Botox is injected into the muscle. In some patients, one side is performed, and in others it is elected to inject both sides of the voice box.

The procedure itself can take only a few minutes to perform, depending on a person’s anatomy. During the injection, patients notice a sensation to have to cough or swallow. We ask that they try to focus on something else, as the muscles we are trying to locate are very small, and coughing and swallowing can move the localization needle out of appropriate position.

After the procedure, patients notice no improvement in their voice for approximately three days. The voice can become very weak and breathy over the course of the subsequent two weeks.

Thereafter, it returns to a more normal quality, and patients note relief in their voice disorder.

In the AB type, the injection is done with the patient sitting up. For those patients with AB spasmodic dysphonia, we have to locate a muscle that is in the back of the voice box. This is also accomplished using electromyographic (EMG) localization.

Those patients with AB spasmodic dysphonia will generally undergo laryngoscopy prior to the procedure to determine which side of the voice box should be injected.