EMG Guided Botulinum Toxin Injection for Adductor Spasmodic Dysphonia

Video Type: CVideo
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Author: Hagit Shoffel-Havakuk
Specialties: Laryngology, Otolaryngology
Schools: University of Southern California
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Basic Info

Contributors: Christian Lava, Hagit Shoffel-havakuk, and Michael M Johns Iii

Adductor spasmodic dysphonia is the most common form of laryngeal dystonia, causing inappropriate glottic closure and strangled choppy voice. This video demonstrates step by step, the standard treatment for adductor spasmodic dysphonia: bilateral, EMG-guided, percutaneous botulinum toxin injections to the TA-LCA (thyroarytenoid and lateral cricoarytenoid) muscles.



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.

Preoperative Workup

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

Anatomy and Landmarks

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.

Disclosure of Conflicts






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