Surgery or botulinum toxin for adductor spasmodic dysphonia: a comparative study

Ann Otol Rhinol Laryngol. 2012 Apr;121(4):231-8. doi: 10.1177/000348941212100408.


Objectives: Currently, botulinum toxin (Botox) injection is the standard of treatment for adductor spasmodic dysphonia (ADSD). We sought to compare the outcome of selective laryngeal adductor denervation-reinnervation (SLAD-R) surgery for ADSD to that of Botox injections.

Methods: Patient-oriented measures (VHI-10) and objective single-blinded gradings of digital voice recordings were utilized as outcome measures. The surgical cohort, recruited by retrospective patient selection, consisted of 77 patients with a mean follow-up time of 7.54 +/- 2.55 years (range, 2.2 to 14.2 years). The injection cohort, recruited prospectively, included 28 patients with a mean follow-up time of 46.37 +/- 5.51 days (range, 36 to 54 days).

Results: As measured by the VHI-10, the surgical patients had significantly improved voice handicap outcome scores (mean, 14.4 +/- 13.6) as compared to the patients who had Botox injection (mean, 26.5 +/- 12.1; p = 0.001). Aside from VHI-10 item 2, the surgical group demonstrated significantly improved voice-related function on each VHI-10 component (p = 0.01). Within the injection subgroup, 88% agreed that Botox successfully treats their ADSD, yet only 63% agreed that Botox improves their speech consistently. Within the surgical subgroup, 82% would recommend this surgery to others, and 78% agreed that their voice was actually better after surgery than after Botox. Objective voice ratings demonstrated similar levels of breathiness and overall voice quality in the treatment subgroups.

Conclusions: When indicated, the SLAD-R surgery for ADSD demonstrates outcomes equal to or superior to those of the current standard of Botox injections.

Publication types

  • Comparative Study

MeSH terms

  • Botulinum Toxins, Type A / therapeutic use*
  • Dysphonia / drug therapy*
  • Dysphonia / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intramuscular
  • Laryngeal Muscles / drug effects
  • Laryngeal Muscles / innervation
  • Laryngeal Muscles / surgery
  • Laryngismus / drug therapy*
  • Laryngismus / surgery*
  • Male
  • Middle Aged
  • Muscle Denervation
  • Neuromuscular Agents / therapeutic use*
  • Prospective Studies
  • Retrospective Studies
  • Single-Blind Method
  • Speech
  • Voice Quality


  • Neuromuscular Agents
  • Botulinum Toxins, Type A