Botulinum toxin injection - larynx

BTX is injected into the muscles around the vocal cords. This weakens the muscles and improves voice quality. It is not a cure for laryngeal dystonia, but can help ease the symptoms.

In most cases, you will have the BTX injections in your health care provider's office. There are two common ways to inject BTX into the larynx:

Through the neck:

• You may have local anesthesia to numb the area.
• You may lie down on your back or remain sitting up. This will depend on your comfort and your provider's preference.
• Your provider may use an EMG (electromyography) machine. An EMG machine records the movement of your vocal cord muscles through tiny electrodes placed on your skin. This helps your provider guide the needle to the correct area.
• Another method involves using a flexible laryngoscope inserted through the nose to help guide the needle.

Through the mouth:

• You may have general anesthesia so you are asleep during this procedure.
• You may also have numbing medicine sprayed into your nose, throat, and larynx.
• Your provider will use a long, curved needle to inject directly into the vocal cord muscles.
• You provider may place a small camera (endoscope) into your mouth to guide the needle.

You would have this procedure if you have been diagnosed with laryngeal dystonia. BTX injections are the most common treatment for this condition.

BTX injections are used to treat other problems in the voice box (larynx). They are also used to treat many other conditions in different parts of the body.

You may not be able to talk for about an hour after the injections.

BTX can cause some side effects. In most cases, these side effects only last a few days. Some of the side effects include:

• A breathy sound to your voice
• Hoarseness
• Weak cough
• Trouble swallowing
• Pain where the BTX was injected
• Flu-like symptoms

In most cases, BTX injections should improve your voice quality for about 3 to 4 months. To maintain your voice, you may need injections every few months.

Your provider may ask you to keep a diary of your symptoms to see how well and how long the injection is working. This will help you and your provider find the right dose for you and to decide how often you need treatment.

Injection laryngoplasty; Botox - larynx: spasmodic dysphonia - BTX; Essential voice tremor (EVT) - btx; Glottic insufficiency; Percutaneous electromyography-guided botulinum toxin treatment; Percutaneous indirect laryngoscopy-guided botulinum toxin treatment; Adductor dysphonia - BTX; OnabotulinumtoxinA - larynx; AbobotulinumtoxinA

Akst L. Hoarseness and laryngitis. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2023. Philadelphia, PA: Elsevier; 2023:28-33.

Blitzer A, Kirke DN. Neurologic disorders of the larynx. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 57.

Flint PW. Throat disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 401.

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.