Botulinum toxin (e.g., Botox®) has been used for many years (since at least 1984) to help patients with spasmodic dysphonia and essential tremor of the voice. Botulinum toxin is a naturally occurring substance that is injected into muscles to temporarily weaken them. It is best known as a cosmetic treatment to remove wrinkles of the face but is commonly used as a treatment for neurologic voice conditions.  

What to Expect During Boxtox Therapy for Voice Disorders

To treat patients with neurologic voice conditions, a small needle is placed into the correct laryngeal muscles with the help of electromyography (EMG), a technique that shows the electrical activity of the muscles in the larynx to ensure exact and precise delivery of the botulinum toxin. After this quick and relatively painless injection, patients may go about with their normal daily activities. Patients can expect the botulinum toxin to begin working two to three days after the injection but this may vary from patient to patient.        

What to expect after the injection: 

  • Mild bruising at the injection site that may be treated with a small ice pack 
  • The botulinum toxin usually “kicks in” by day 2-3 after injection, but this may vary from patient to patient 
  • There may be an initial “down-time” where the voice may become breathy and more whisper like that usually improves by 2-3 weeks after injection 
  • Ideal results will be a voice with fewer “voice breaks” 
  • Ideal longevity of the botulinum toxin is sustained good voicing lasting an average of 10-12 weeks after the injection 
  • You may start to notice increased voice spasms/breaks around 2.5 to 3 months after the injection – this means another treatment is needed 
  • Stress and colds/illnesses may affect the voice following injection