Botulinum Toxin (Botox) Injections
In the early 1980s with the introduction of laryngeal botulinum toxin A (Botox) injections as a therapeutic option, treatment of spasmodic dysphonia (SD) patients became concentrated in a few centers. Dr. Jamie Koufman, director of the Voice Institute of New York, was one of the very first and has treated thousands of patients with SD over the past 20 years.
Dr. Koufman employs all of the different techniques of Botox injection including EMG-guided injections. EMG (electromyography) is an instrument that measures electricity of the laryngeal muscles, and therefore, almost ensures accuracy of injections. Dr. Koufman has stated that 95% of her patients get excellent results. Botox injections take only a few minutes, and the doses are customized for each patient so that patients can have relief of voice symptoms without prolonged periods of breathiness.
Some patients have difficulty with swallowing because of a misbehaving upper esophageal valve (also known as the upper esophageal sphincter or UES). The UES is commonly the cause of a sensation of a lump in the throat called globus pharyngeus. At the Voice Institute of New York high-definition manometry actually records and analyzes swallowing, specifically isolating the swallowing mechanisms related to the UES. Botulinum toxin injections are also effective for many swallowing problems.