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Botulinum toxin injection - larynx

  • Definition
    • Botulimum toxin (BTX) is a type of nerve blocker. When injected, BTX blocks nerve signals to muscles so they relax.

      BTX is the toxin that causes botulism, a rare but serious illness. It is safe when used in very small doses.

  • Alternative Names
    • 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

  • Description
    • 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 2 common ways to inject BTX into the larynx:

      Through the neck:

      • You may have local anesthesia to numb the area.
      • You will lay down on your back.
      • 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 thru 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.
  • Why the Procedure is Performed
    • 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.

  • After the Procedure
    • 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
      • Flulike symptoms
  • Outlook (Prognosis)
    • 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.

  • References
    • Blitzer A, Alexander RE, Grant NN. Neurologic disorders of the larynx. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 60.

      Krishna P, Rosen CA. Office-based laryngeal procedures. In: Myers EN. Operative Otolaryngology: Head and Neck Surgery. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 36.

      Van Houtte E, Van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice. 2011;25:202-7.