Gender differences in onabotulinum toxin A dosing for adductor spasmodic dysphonia

Laryngoscope. 2017 May;127(5):1131-1134. doi: 10.1002/lary.26265. Epub 2016 Sep 16.


Objectives/hypothesis: The objective of this study was to determine the influence of gender on onabotulinum toxin A dosing for the treatment of adductor spasmodic dysphonia symptoms.

Study design: Retrospective review.

Methods: A chart review of the senior author's database of botulinum toxin injections was performed. Patients diagnosed with adductor spasmodic dysphonia who received onabotulinum toxin A (BoNTA) injections to the thyroarytenoid muscle for at least 5 years were included for study. Patients who received alternate formulations of botulinum toxin (Myobloc, Dysport, or Xeomin) and patients with alternate diagnoses, such as abductor spasmodic dysphonia, tremor, and oromandibular dystonia, were excluded. The average BoNTA dose was calculated for each patient and statistical analysis was performed comparing the male and female groups.

Results: A total of 201 patients (52 males and 149 females) met inclusion criteria. The average follow-up times for the male and female groups were 10.2 ± 3.6 and 11.1 ± 4 years, respectively. The average BoNTA doses for the male and female groups were 0.6 ± 0.42 U and 1.3 ± 1.1 U, respectively. Statistical analysis was performed using an independent samples two-tailed t test yielding a P value of .0000000002. A large effect size was noted with Cohen's d = 0.85.

Conclusions: The data from this retrospective chart review reveal a statistically and clinically significant correlation between female gender and higher average BoNTA dose for symptom control in adductor spasmodic dysphonia. Explanations for this observation are speculative and include a possible inverse relationship between optimal BoNTA dose and vocal fold mass and possibly greater neutralizing antibody formation among female patients.

Level of evidence: 4. Laryngoscope, 127:1131-1134, 2017.

Keywords: Botox; Spasmodic dysphonia; botulinum toxin; dystonia; gender; onabotulinum toxin; voice.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / therapeutic use*
  • Dysphonia / drug therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / therapeutic use*
  • Retrospective Studies
  • Sex Factors
  • Treatment Outcome


  • Neuromuscular Agents
  • Botulinum Toxins, Type A