By Elizabeth Weise
USA Today
April 20, 2004

Having Botox injected into your vocal cords might not sound like fun, but for the nation's estimated 15,500 suffers of the voice disorder spasmodic dysphonia, it's a godsend.

Botox is best known for its powers to reduce wrinkles. But a new study validates the almost decade-long use of the potent neurotoxin to quell the voice disorder that gives a strained, broken or sometimes breathy tone to people who have the condition, who include Robert F. Kennedy Jr. and National Public Radio's Diane Rehm.

Norman Hogikyan of the University of Michigan followed 42 patients for three years to gauge how long and how well the treatments worked. The study, published in the April issue of the Archives of Otolaryngology, found that patients typically needed follow-up Botox shots two or three times a year but did significantly better both socially and emotionally.

Emotionally is important, because people with the disorder can have voices that sound strangled or as if they are about to cry. Because the disorder is so rare, few physicians are familiar with it.

"It can be misconstrued as an emotional or even psychiatric disorder, but it's absolutely not that. It's a neurological-control disorder manifesting in the vocal cords," says Hogikyan, who directs the University of Michigan Vocal Health Center.

It can often take years for patients to be diagnosed correctly and get appropriate treatment. Many are reluctant to speak in public and find themselves becoming increasingly isolated.

"The number of suffers could be much larger because so many patients are misdiagnosed," says Robert McAlister, executive director of the National Spasmodic Dysphonia Association. "Botox is definitely the cat's meow when it comes to this disease."

Botulinum toxin type A, aka Botox, is used to ease the symptoms of an increasing number of ailments tied to muscle function, including cerebral palsy and Tourette's syndrome.

With spasmodic dysphonia, which is caused by the involuntary movement of muscles in the larynx, Botox relaxes those muscles in the same way it relaxes the muscles in the furrowed foreheads of those who use it for cosmetic reasons.

Treatment involves first numbing the skin of the neck and then injecting Botox directly into the vocal cords.

This temporarily disconnects the nerve-to-muscle signals and reduces abnormal muscle activity while still allowing normal speech.

Before Botox, patients either lived with the disorder or tried a surgical procedure that severed some of the nerves but didn't provide lasting benefit, Hogikyan says.