Botulinum Toxin Treatment
Botulinum toxin relaxes a muscle by blocking the signal from its nerve for a period of months. In laryngology it is used to calm muscles that are working abnormally, in the voice box and at the top of the oesophagus.
Where it is used
- spasmodic dysphonia (laryngeal dystonia), where it is the mainstay of treatment
- vocal tremor, in selected patients
- R-CPD, the inability to belch, injected into the cricopharyngeus muscle
- cricopharyngeal dysfunction affecting swallowing
What happens
For the vocal folds, the injection is usually given in the clinic, through the neck or with endoscopic guidance, with electromyography to confirm the position of the needle where helpful. For R-CPD it is usually performed in theatre under brief general anaesthesia, with an awake option for patients who prefer it.
Recovery and results
The effect appears over days and wears off over months. In spasmodic dysphonia, a period of breathiness after injection is common before the voice settles; the dose is adjusted over time. After an R-CPD injection, temporary difficulty swallowing is the commonest side effect.
Medically reviewed by
Associate Professor Necati Enver, MD
Laryngologist · Founder and Director, Istanbul Voice Center · Reviewed September 2026
General information only. It does not replace an individual assessment. Medical disclaimer
Frequently asked questions
Is botulinum toxin treatment in the larynx cosmetic?
No. In the larynx and throat, botulinum toxin is used to relax specific muscles that are working abnormally, for example in spasmodic dysphonia or R-CPD.
How long does it take to work?
The effect usually begins within a few days and builds over one to two weeks.
Does it need to be repeated?
For spasmodic dysphonia, yes, typically every few months. For R-CPD, many patients need a single injection because the belch reflex, once established, often persists.
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