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November 1987

Botulinum Toxin for Relief of Spasmodic Dysphonia-Reply

Author Affiliations

New Orleans

Arch Otolaryngol Head Neck Surg. 1987;113(11):1240. doi:10.1001/archotol.1987.01860110106026

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In Reply.—I can assure Dr Gacek that we are very aware of his research on the localization of motor end plates in laryngeal muscles, and that we are not ignoring this important work. Our preliminary experiment was performed to determine if botulinum toxin (BT) would be useful in patients with spasmodic dysphonia. The electromyographic technique was chosen because it was the simplest, least invasive means of administering the BT, and it has been used to inject BT into the extraocular muscles. However, it does not permit localization of the BT to discrete anatomic areas within a muscle with any certainty. It may be that the diffusion of BT within a muscle is such that precise localization is neither desirable nor necessary. Furthermore, I suspect that the only way to obtain such fine control of the injection would be by visual inspection, which would require direct laryngoscopy or, perhaps, a

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