Botulinum toxin injections for laryngeal disorders.

Abstract

Purpose of review: This review summarizes recent advances in the use of botulinum toxin (BoNT) for laryngeal disorders. It highlights the growing therapeutic relevance of BoNT across both motor and sensory conditions, focusing on novel indications, evolving mechanisms of action, and innovations in injection techniques.

Recent findings: BoNT remains the primary treatment for laryngeal dystonia, with increasing personalization in dosing, target selection, and outcome assessment. New evidence supports its application in functional dysphonia, vocal process granuloma, chronic cough, inducible laryngeal obstruction, and abnormal throat sensation. Studies suggest both peripheral and central neuromodulatory effects, including modulation of afferent input and neuroplastic changes. Guidance techniques such as electromyography, ultrasound, and flexible endoscopy are improving injection accuracy. Adjunctive therapies, including pharmacological agents and sensory retraining approaches, show promise for partial or nonresponders.

Summary: BoNT is an increasingly versatile and well tolerated treatment across a broadening spectrum of laryngeal disorders. As knowledge of laryngeal neurobiology expands, BoNT is being redefined as both a focal therapeutic and a neuromodulator with broad implications for voice and airway management.