Abstract
A group of 58 patients with spasmodic dysphonia was treated perorally or transcutaneously with botulinum toxin injection, and followed up for at least six months. Most were treated by peroral injection using indirect laryngoscopy to facilitate precise placement. An effort was made to disperse the toxin over the entire thyroarytenoid muscle to affect the greatest number of motor end-plates with the smallest effective dose. Severely symptomatic patients with primarily adductor spasmodic dysphonia had the best results. A potentiation effect is suggested by analysis of a subpopulation of patients, mostly injected unilaterally, in which outcome was more favorable in those who had had prior injections. One-month post-injection studies reflect significant improvement in measured read ings of a standard passage and this is consistent with the subjective and per cep tu al improvements noted. There were no severe complications. Peroral injection seems inadvis able in patients with mixed or abductor spasmodic dysphonia as well as in those patients with an un con trol la ble gag reflex.

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