Liquid-type Botulinum Toxin Type A in Adductor Spasmodic Dysphonia: A Prospective Pilot Study

J Voice. 2017 May;31(3):378.e19-378.e24. doi: 10.1016/j.jvoice.2016.07.004. Epub 2016 Aug 9.


Objectives: Botulinum toxin (BTX) has been widely used to treat adductor spasmodic dysphonia (ADSD). Most commercially available forms of BTX require reconstitution before use, which may increase the risk of contamination and requires careful titration. Recently, a liquid-type BTX type A (BTX-A) has been developed, which should simplify the procedure and enhance its efficacy. Herein, we present a prospective pilot study to investigate the efficacy and safety of liquid-type BTX-A in the treatment of ADSD.

Methods: Twenty-six consecutive liquid-type BTX-A injections were performed in 12 patients with ADSD. We included as a control group 34 consecutive patients with ADSD who had previously undergone 52 vocal fold injection procedures with freeze-dried-type BTX-A.

Results: All patients in both groups had improvement of symptoms related to ADSD and period of normal voice. Most patients experienced breathiness, and the onset time, the peak response time, and the duration of breathiness were similar in both groups. The duration of effect (days) was 96.96 ± 18.91 and 77.38 ± 18.97 in the freeze-dried-type and the liquid-type groups, and the duration of benefit (days) was 80.02 ± 18.24 and 62.69 ± 19.73 in the freeze-dried-type and the liquid-type groups. To compare the efficacy between the freeze-dried-type and the liquid-type BTX-A, the sessions of the unilateral vocal fold injection were included and were categorized as group A (1 ~ 2 units BTX-A) and group B (2 ~ 3 units BTX-A), according to the dose per vocal fold. There was no significant difference of effect time between freeze-dried-type and liquid-type BTX-A groups. No adverse events related to BTX or vocal fold injection were reported.

Conclusions: Liquid-type BTX-A is safe and effective for the treatment of spasmodic dysphonia. With the advantages of simple preparation, storage, and reuse and animal protein-free constituents, liquid-type BTX-A may be a good option in the treatment of spasmodic dysphonia.

Keywords: Botulinum toxin; Focal dystonia; Liquid-type; Spasmodic dysphonia; Vocal fold injection.

MeSH terms

  • Acetylcholine Release Inhibitors / administration & dosage*
  • Acetylcholine Release Inhibitors / adverse effects
  • Acetylcholine Release Inhibitors / chemistry
  • Adult
  • Botulinum Toxins, Type A / administration & dosage*
  • Botulinum Toxins, Type A / adverse effects
  • Botulinum Toxins, Type A / chemistry
  • Case-Control Studies
  • Drug Compounding
  • Dysphonia / diagnosis
  • Dysphonia / drug therapy*
  • Dysphonia / physiopathology
  • Female
  • Freeze Drying
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Pharmaceutical Solutions
  • Pilot Projects
  • Prospective Studies
  • Recovery of Function
  • Time Factors
  • Treatment Outcome
  • Vocal Cords / drug effects*
  • Vocal Cords / physiopathology
  • Voice Quality / drug effects*


  • Acetylcholine Release Inhibitors
  • Pharmaceutical Solutions
  • Botulinum Toxins, Type A