Effect of Botulinum Toxin and Surgery among Spasmodic Dysphonia Patients

Otolaryngol Head Neck Surg. 2017 Feb;156(2):238-254. doi: 10.1177/0194599816675320. Epub 2016 Nov 1.


Objective The effect of botulinum toxin among patients with adductor spasmodic dysphonia (AdSD) is temporary. To optimize long-term treatment outcome, other therapy options should be evaluated. Alternative treatment options for AdSD comprise several surgical treatments, such as thyroarytenoid myotomy, thyroplasty, selective laryngeal adductor denervation-reinnervation, laryngeal nerve crush, and recurrent laryngeal nerve resection. Here, we present the first systematic review comparing the effect of botulinum toxin with surgical treatment among patients diagnosed with AdSD. Data Sources MEDLINE (PubMed), EMBASE, and the Cochrane Library. Methods Articles were reviewed by 2 independent authors, and data were compiled in tables for analysis of the objective outcome (voice expert evaluation after voice recording), the subjective outcome (patient self-assessment scores), and voice-related quality of life (Voice Health Index scores). Results No clinical trials comparing both treatment modalities were identified. Single-armed studies evaluated either the effect of botulinum toxin or surgical treatment. Thirteen studies reported outcomes after botulinum toxin treatment (n = 419), and 9 studies reported outcomes after surgical treatment (n = 585 patients). A positive effect of bilateral botulinum toxin injections was found for the objective voice outcome, subjective voice outcome, and quality of life. The duration of the beneficial effect ranged from 15 to 18 weeks. Surgical treatment had an overall positive effect on objective voice improvement, subjective voice improvement, and quality of live. Conclusion No preference for one treatment could be demonstrated. Prospective clinical trials comparing treatment modalities are recommended to delineate the optimal outcomes by direct comparison.

Keywords: Botox; botulinum; injections; spasmodic dysphonia; surgery.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / therapeutic use*
  • Dysphonia / drug therapy*
  • Dysphonia / physiopathology
  • Dysphonia / surgery*
  • Humans
  • Injections, Intramuscular
  • Laryngeal Muscles / drug effects
  • Laryngeal Muscles / innervation
  • Laryngeal Muscles / surgery
  • Laryngismus / drug therapy*
  • Laryngismus / surgery*
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / therapeutic use*
  • Quality of Life
  • Voice Quality


  • Neuromuscular Agents
  • Botulinum Toxins, Type A