Treatment of Speech and Voice Disorders With Botulinum Toxin

SELECTED CASE A 37-YEAR-OLD woman presented to the Speech and Voice Unit of the National Institutes of Health, Bethesda, Md, with a 5-year history of a voice disorder of unknown etiology. The disorder began after an upper respiratory infection, when she developed hoarseness that persisted for several weeks. Indirect laryngoscopy 1 month after onset revealed no abnormalities: the vocal folds appeared normal and moved symmetrically. The symptoms progressed during the succeeding months; her voice became difficult to control, with frequent pitch and voice breaks. Speech therapy provided no lasting benefit. Because she had been undergoing a divorce and had a stressful job, her physician suggested psychological counseling. She discontinued counseling after a 3-month trial afforded no benefit. The symptoms progressed during the next 2 years and then stabilized, sometimes aggravated by stress and voice use. During the next few years she sought relief with hypnosis, acupuncture, and various medications, including