In office EMG guided Botulinum Toxin injection for Adductor Spasmodic Dysphonia, in an awake patient.

The general indication is Adductor Spasmodic Dysphonia. However, there are several other indications such as, essential voice tremor with glottal stops and vocal fold granuloma.

- Known Hypersensitivity to Botulinum Toxin. - Pregnancy - Breast feeding - Neuromuscular junction diseases such as myasthenia gravis. - Aminoglycoside treatment

An in office procedure, the patient is seated in a comfortable chair. EMG machine is operated by the assistant, reference and ground electrodes are attached to the patient¢ïïs skin using surface electrodes. Insulated 26G needle electrode is used for the injection of Botulinum Toxin.

- Perceptual assessment of voice. - Careful laryngoscopic examination with videostroboscopy in order to exclude other laryngeal pathology. - Through neurologic physical examination and evaluation.

Thyroid cartilage; cricoid cartilage; cricothyroid membrane.

Patients' cooperation is required. In general the procedure should be repeated every 3 months. There is no standard botulinum toxin dose, the ideal dosage differ between patients. Advantages: in office procedure, effective treatment.

Patients should be advised of breathiness and dysphagia to liquids during initial period after injection.

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