Botulinum toxin injection under electromyographic guidance is the ‘gold standard’ for adductor spasmodic dysphonia treatment. The point-touch technique, an alternative injection method which relies on anatomical landmarks, is cheaper, quicker and more accessible, but has not yet gained widespread acceptance due to concerns about patient satisfaction.

To assess swallowing and voice-related quality of life following point-touch botulinum toxin injection in adductor spasmodic dysphonia patients.

Stanford University Voice and Swallowing Center.

Prospective case series (evidence level four).

Consecutive adductor spasmodic dysphonia patients with a stable botulinum toxin dose–response relationship were recruited prospectively. The Eating Assessment Tool and Voice-Related Quality of Life questionnaires were completed pre-treatment and at 10 and 30 per cent completion of the injection cycle, respectively.

Thirty-seven patients completed follow up. The mean total botulinum toxin dose was 0.88 units. Pre-treatment Voice-Related Quality of Life questionnaire results reflected the burden of disease. Post-treatment Eating Assessment Tool and Voice-Related Quality of Life questionnaire results were collected at 2.53 and 7.84 weeks, respectively; the former showed an increase in dysphagia, albeit statistically insignificant, while the latter showed significantly improved scores (both domain and total).

The point-touch technique is a viable alternative for botulinum toxin injection in the treatment of adductor spasmodic dysphonia.

Selective lateral laser thyroarytenoid myotomy is a conceptually sound, simple, minimally invasive, repeatable and predictable new surgical procedure for treating adductor spasmodic dysphonia. This paper aims to introduce and describe the surgical technique, and to present a clinical case series and its outcomes.

A prospective, clinical case series treated with selective lateral laser thyroarytenoid myotomy, with follow up of 2.5 years.

Pre- and post-operative data were collected prospectively for patients undergoing selective lateral laser thyroarytenoid myotomy. These data included patient demographics, previous interventions for adductor spasmodic dysphonia, technical aspects of surgery and clinical outcome. Outcome data included clinical assessment, voice handicap index, need for further intervention, and patient satisfaction assessed by subjective improvement (detailed subjectively by the patients themselves and objectively using the Glasgow benefit inventory).

Four patients (two men and two women; mean age 65 years; age range 41–80 years) were included. The mean duration of adductor spasmodic dysphonia was 11 years. All patients had previously been treated with botulinum toxin A. All patients reported improvement in voice quality, fluency, sustainability and elimination of voice breaks over 2.5 years' follow up. Clinical assessment revealed no alteration in mucosal wave, and complete relief of hyperadduction was observed on phonation. No patients required supplementary botulinum toxin treatment during follow up.

Selective lateral laser thyroarytenoid myotomy seems to represent a curative procedure for adductor spasmodic dysphonia, a chronic, debilitating condition. This procedure is conceptually simple, minimally invasive and repeatable. It also seems to offer a safe and lasting alternative to botulinum toxin therapy.

Office-based laryngeal injection for the treatment of a variety of voice disorders is an established practice. Various methods of delivery to the vocal folds are in practice.

We present a simple and repeatable method of injecting botulinum toxin into the larynx.

Botulinum toxin A (Botox®) was delivered into the larynx using a channelled fibre-optic laryngoscope under local anaesthetic, in an office setting.

Seven patients received regular botulinum toxin injections, via our preferred method. The treatment intervals and dosage regime varied depending on patient requirements. The procedure was carried out in an office setting, with minimal discomfort and inconvenience to the patient.

We present a method of botulinum toxin delivery to the larynx which is simple, easily repeatable and simply learnt by the otolaryngologist familiar with fibre-optic laryngoscope usage. This method is also comfortable and convenient for the patient.