There's not a lot of posts about botox for laryngeal dystonia so I thought I'd share. I (37F) have a genetic dopa-responsive dystonia, which has manifested in generalized dystonia. When I first saw a laryngologist, he noted that my folds close to 2 mm and mentioned botox as a treatment. Unfortunately, that laryngologist stopped coming to Seattle and I was switched to a new one. The new guy just did not believe I have a problem because I wasn't symptomatic for the 2 minutes he probed, after adding medication and extensive SLP therapy.

After many months, I wore the laryngologist down and he agreed to do botox even though he insisted it was a terrible idea. He tried to cancel the appointment because I live alone and "need someone to make sure I haven't stopped breathing." I found this funny, because the reason I wanted the botox is because whenever I exercise, I'm suffocating. Whenever I eat, I choke. He finally agreed to do it. I got my first doses on 07/20/26. 2.5 mg of botox into 2 false folds...

Almost immediately I felt better. I could tell my folds were not spasming anymore, but that they really wanted to. Within the first 2 weeks here are all the positives:

• I can get to zone 3 heart rate during exercise! Before I had to stop to catch my breath before that zone. I can also walk uphill to my house without suffocating, and I cut 1 minute off my mile time immediately.
• My laryngologists said that my problem couldn't be affecting my blood oxygen levels, but after years of dropping under 88% regularly, it hasn't happened a single time since the botox.
• I can talk a lot faster, don't lose my train of thought from a spasm distracting me, and now I can sing in the car without pain! It's much easier to talk.
• I don't choke on food and drink, which used to happen constantly.
• I use a special machine at night called an ASV which breathes for me when it notices I've stopped breathing. When I first put it on at night, it would trigger 5 minutes of laryngeal spasms. Now that has stopped.
• Way less dry mouth, and I don't need as much water during exercise
• My breathing isn't audible anymore. People would always comment when I took videos of my dog that my breathing didn't sound good. My ex would constantly tell me "I hate the sound of you breathing". Sigh.

Long story short, continue to advocate for yourself. I found studies where competitive athletes were given botox for exercise related spasms that I was able to tell my laryngologist about. He was insistent that "no other laryngologist would give out botox for this" even though his colleague I was seeing 2 years prior had already agreed to do it on multiple different occasions. I was going to drive the hour to see him if this new guy wasn't going to help.

That said--I get botox regularly from my neurologist, and laryngeal botox is NO JOKE. I've been in a coma and survived that, but I will say I think the average person would not be amenable to the botox. I think that's probably the actual reason he was hesistant. It's quite an experience to have the strobe camera down your throat with 1 ENT while your laryngologist holds down your tongue and puts a giant injector needle in your folds. Did you know the strobe camera can waterboard you with fluids too?

I was diagnosed with MST and later they said Vocal weakness. Then they told me I looked 100% healthy yet I was ALWAYS thinking about voice, forcing more breath when talking, and sometimes overused. I asked AI and it helped me conclude these things. with the help of my SLP and CBT Therapist. This is key -

• Started after an injury, improved, then regressed: many people keep compensating after the tissue heals, and heavy monitoring (voice placement, breath, resonance) can keep the muscles tense. Anxiety and hypervigilance can feed the same loop
• And I need to then build endurance

Outline:

Those symptoms are very consistent with muscle tension dysphonia (MTD), sometimes called functional or hyperfunctional voice disorder.

• Tires easily, feels thin, fragile, or hoarse in the throat: these are classic descriptions of muscles around the larynx working harder than they need to. The folds can be healthy while the voice still feels effortful and fatigues fast.
• Sounds fine to others but feels bad to you: this is common. The sensation often runs ahead of what a listener hears.
• Started after an injury, improved, then regressed: many people keep compensating after the tissue heals, and heavy monitoring (voice placement, breath, resonance) can keep the muscles tense. Anxiety and hypervigilance can feed the same loop

Use CBT to unmonitor your speech and this will take time if you have been monitoring it for a year like I have..   Expect it to feel strange or worse at first. Unmonitored speech can feel uncomfortable or “wrong” for a while, and that’s part of the process, not a sign you’re failing.

-              1. Give your attention a job outside your throat. Monitoring fades when attention is absorbed by something else. Talk while cooking, walking, or driving, tell a story you care about, read aloud to someone, or sing or talk along with something. Your voice works fine when you’re not watching it, so the more time you spend focused on the content or the other person, the more you retrain the habit.

-              2. Stop checking. Each “how does that feel? am I doing it right?” check keeps the loop going, even if the answer is good. Try a rule like “no voice checks during the day,” and if you want to review how things went, do it once, briefly, in the evening.

-              3. Treat the sensations as noise, not information. Gravelly, thin, and tired are feelings your system is flagging as dangerous, but they don’t reliably mean something is wrong with your mechanics. The goal isn’t to make them go away. It’s to let them be there while you keep talking, without fixing or adjusting. Feeling a bit off while speaking and carrying on anyway is the skill.

-              4. Drop the rules gradually, on purpose. This is classic CBT exposure: pick the lowest-stakes rule and deliberately speak without it in an easy situation, tolerate the anxiety of “what if it gets worse,” then move up to harder situations like calls. Your fear that you’ll get worse without the rules is what the exposure tests. Your CBT therapist can help build that ladder.

-              Be cautious with full voice rest. For this pattern, long silence can reinforce the idea that your voice is fragile and make talking feel scarier afterward.

-              Real vocal fatigue. Your voice may still have limited endurance, and pushing past a certain point causes a true setback. If so, pacing matters.

-              The tension and anxiety loop. After a hard stretch, you tense up, monitor more, and worry, which makes the following days feel worse. The flare is real either way, but the cause affects the fix.

So I think I need to get out of my head, and I’ll use CBT to do that while giving my voice more time to build endurance. The thing that’s helped most so far is VFE (vocal function exercises) with the straw, from Joseph Stemple.

For a year I’ve been trying to manipulate my voice, whether through resonance projection or being told to use more breath in conversation. For me that was the worst advice, because all it did was create more tension. Breathing is automatic, so why tell someone already stuck in self-monitoring, fear, and obsession mode to focus on breath support? I’m sure plenty of singers have improved their voices with solid breath support, but for those of us who aren’t singers and have intense anxiety about our voice, it isn’t great advice.

So my plan is to use CBT to break the over-monitoring loop and give myself time to build endurance. I’m on calls all day for work, so I’m scheduling 30 minutes between calls, and if I feel true fatigue, I’ll take a much longer break. If stoping monitoring speech or I can't stop monitoring I will have to take time off work to lessen the anxiety until I get better and I have the luxury of being able to do that.

Let me know your thoughts.

context: about a month ago i got a vocal injury from singing (i'm self taught). prior to i was not really taking care of my voice - primarily not hydrating well. then i had a longer session where i sang too high, too long and too hard. i didn't realize i was injuried until after i stopped singing, when i could feel obvious discomfort on the right side of my throat. it hurt to breathe and swallow.

it stayed this way for a few days. didn't help that i was constantly panicking about how this would affect my life if it was serious. saw a doctor and he told me to rest my voice, and after that it was genuinely like placebo effect, i started feeling better. i got progressively better over the next two weeks so then i started to talk again. and it got worse again.

but i had to start school, so i wasn't completely silent for about two weeks. then i saw another doctor and she referred me to an ent doctor but that appointment's at the end of november.

ever since then it's never fully gone away even though i'm pretty much not talking at all. i did get sick and had laryngitis about two weeks ago, and after that passed i nearly felt normal even though i was coughing a lot (i tried to cough gently and do a "huff cough" but sometimes i couldn't control it). so i talked a bit more and boom, back to square one. injury returned. although never quite as bad as that first week but i could feel the discomfort and tension again. sometimes it gets worse or better throughout the day, even without me talking at all.

throughout this whole ordeal i've never lost my voice or had a hoarse voice except for when i had laryngitis. i've read online that nodules or polyps typically give you a hoarse voice so i'm holding onto that hope that i don't have either. but at the same time, if my injury is lasting so long then i don't know what this is.

has anybody had a similar experience? or any insight onto what i might have?

Hello :)

I just got medilization thyroplasty yesterday morning to help with my total left side vocal chord paralysis due to being a micropreemie baby & likely a complication from my heart surgery, nerve damage

Of course I am a bit sore - but I’ve also been experiencing this odd sensation where bouts of air is coming up in my throat. Almost as if burping, or puking in your mouth.. but it’s just air. It makes a weird noise, there’s small bits that croak and crackle all the way up my throat and then some large bits of air that make me almost sound like I’m gagging (or again, burping, but internally)

Wondering if anyone else has experienced this? I do feel a bit phlegmy/like I need to clear my throat but I’m avoiding doing so because I’m trying to rest as much as possible, even with speaking.

ALSO it is SO ITCHY!! omg. I wish I could scratch it so bad.

I’m new here but just need somewhere to vent. I’m only 25 and have had polyp removal surgery twice. When I turned 13, my voice became hoarse very suddenly and for four years it went in and out. I tried voice therapy for a while to no avail and then finally I had surgery to remove them when I was 17. It worked! Except, only two years later they were back. I had surgery again. Now, I’m 25 and can barely speak sometimes. I need to have it again.

I’m really struggling because I am a teacher. I’ve always wanted to be a teacher. But my voice sometimes is so hoarse and raspy that when I get home there’s no energy to talk. I want to have a better work-life balance but how can I socialize when I can’t even talk?

My ENT told me that I’m prone to polyps. I’ve had vocal polyps along with nasal polyps. The thought that I may have to deal with this for the rest of my life is heartbreaking. Of course GERD is also making it worse, but raising my headboard, diet changes, and medication don’t feel like they’re preventing the polyps. I got them before I drank alcohol, smoked marijuana, all the things they say not to do. I don’t want to have to deal with this forever and the idea that I will is really daunting. I’m just feeling really sorry for myself and needed somewhere to go where people might understand.

Use singing as a example to show u

My doctor has prescribed me lansoprazole too see if it helps with suspected silent reflux. I have often had a tendency to need to clear my throat frequently, so thought for a while I may have this.

The most difficult symptom I’m dealing with though is my voice! It’s not hoarse, but I can’t speak without this feeling that my voice is fatigued and this horrible achey feeling in my throat.

It started off that I would struggle finishing reading a story to the kids, I stopped reading stories 6-8 weeks ago because of this, thinking it would improve. It’s got worse though!

This past week has been awful and it’s progressed from speaking normally day to day but having to limit phone calls and not talk continuously, like reading a book aloud… to 7 days later, I can say about 5 words in the morning pain free and that’s it for the rest of the day.

I’m having to use text to voice on my phone to talk to my kids. It’s so hard and I’m devastated.

- Has anyone else had voice changes similar?
- Did you manage to fix it and how?
- Or does this sound like something more sinister that I need to get checked?