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Botulinum toxin injection - larynx

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.

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 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.

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
  • Flu-like 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.

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

References

Blitzer A, Sadoughi B, Guardiani E. Neurologic disorders of the larynx. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 58.

Flint PW. Throat disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 429.

Review Date 10/20/2016

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.