The botulinum toxin A (BOTOX) injection procedure is performed as a collaboration between Otolaryngology and Neurology using electromyographic (EMG) localization. On the day of your injection, you will check in at the ENT clinic, and then be taken to the Neurology clinic, where the injection is completed.

If you have adductor (AD) spasmodic dysphonia, you will be asked to lie on your back with your head extended for the injection. This will allow the surgeon to feel the landmarks of your voice box.

If you have abductor (AB) spasmodic dysphonia, the injection is done while you are sitting up. The surgeon must locate a muscle in the back of the voice box for the injection.

A small injection and localization needle is then used to locate the specific muscles that seem to be overactive. In ADSD, this is the vocalis muscle. In ABSD, this is the posterior cricoarytenoid muscle.

Once the muscle is located, a small amount of botulinum toxin A is injected into the muscle. In some patients, one side is injected, and in others, both sides of the voice box are injected.

The procedure itself can take only a few minutes to perform, depending on a person’s anatomy. During the injection, patients notice a sensation of needing 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, there is no noticeable improvement in the 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 for a few months until the botulinum toxin A begins to wear off.

A patient may experience transient difficulty swallowing liquids. This is generally alleviated by using a chin tuck or thickening liquids for a few days. If there is no improvement or if the condition is worsening after five to seven days, please contact your Duke Voice Care Center physicians.

The botulinum toxin A procedure is performed at specified times that will be arranged on monthly to six-week intervals. After your first injection, you will be notified of future botulinum toxin A clinic dates.

This article is intended as a resource for patients receiving their voice care at Duke Voice Care Center. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.