Cannabinoid Use in the Treatment of Laryngeal Dystonia and Vocal Tremor: A Pilot Investigation

Published in Journal of Voice, 2023

Authors | 1Noah Millman, BS, 2Benjamin van der Woerd, MD, 3Lauren Timmons Sund, CCC-SLP, and 3Michael Johns, MD

1Keck School of Medicine, University of Southern California, Los Angeles, California
2Department of Surgery, Division of Otolaryngology, McMaster University, Hamilton, Ontario, Canada
3Caruso Department of Otolaryngology – Head and Neck Surgery, University of Southern California, Los Angeles, California

Dysphonia International collaborated with Dr. Michael Johns and his colleagues on a study exploring the use of cannabinoids as a treatment for spasmodic dysphonia, a form of laryngeal dystonia. The inspiration for this study arose during a virtual meeting of the Los Angeles Support Group, where a presentation on cannabis highlighted the lack of available data regarding its use in individuals with spasmodic dysphonia. Subsequently, an electronic survey was disseminated to our community, and the study results were published in the Journal of Voice

. We extend our gratitude to Dr. Johns, along with Noah Millman, Benjamin van der Woerd, and Lauren Timmons Sund, for their dedicated work on this research. Below is a concise summary prepared by Dr. van der Woerd, followed by the published abstract.

Over half of the 158 participants had tried using cannabinoids, with about 54% currently incorporating them into their treatment regimen, often without medical guidance. The effectiveness of cannabis products was rated as either “not effective” or “somewhat effective” by most participants, suggesting they may not be suitable as a standalone treatment. Interestingly, some respondents noted that combining botulinum toxin (BTX) injections and cannabis was more potent compared to BTX alone in treating their symptoms.

This study also highlights potential limitations of cannabinoid use, including altered mental status with THC-derived products, potential cognitive slowing with long-term THC use, and inconsistent effects due to variable product preparations.

In conclusion, while many patients have tried or are currently using cannabis products, they are felt to be less or similarly as effective as BTX. The study underscores the need for further investigation to guide clinicians in advising patients on their treatment journey.


Summary: Objectives/hypothesis. Laryngeal dystonia and vocal tremor can be debilitating conditions with suboptimal treatment options. Botulinum toxin chemodenervation is typically the first-line treatment and is considered the gold standard. However, patient response to botulinum toxin varies widely. There is anecdotal evidence for the use of cannabinoids in treating laryngeal dystonia with a scarcity of research investigating this potential treatment option. The primary objective of this study is to survey patients with laryngeal dystonia and vocal tremor to gauge how some people are using cannabinoids to treat their condition and to ascertain patient perceptions of cannabinoid effectiveness.

Study Design. This is a cross-sectional survey study.

Methods. An eight-question anonymous survey was distributed to people with abductor spasmodic dysphonia adductor spasmodic dysphonia, vocal tremor, muscle tension dysphonia, and mixed laryngeal dystonia via the Dysphonia International (formerly National Spasmodic Dysphonia Association) email listserv.

Results. 158 responses: 25 males and 133 females, (mean [range] age, 64.9 [22–95] years). 53.8% of participants had tried cannabinoids for the purposes of treating their condition at some point, with 52.9% of this subset actively using cannabis as part of their treatment. Most participants who have used cannabinoids as a treatment rank their effectiveness as somewhat effective (42.4%) or ineffective (45.9%). Participants cited a reduction in voice strain and anxiety as reasons for cannabinoid effectiveness.

Conclusions. People with laryngeal dystonia and/or vocal tremor currently use or have tried using cannabinoids as a treatment for their condition. Cannabinoids were better received as a supplementary treatment than as a stand-alone treatment.

Key Words: Cannabinoids–Laryngeal dystonia–Muscle tension dysphonia–Vocal tremor–Spasmodic dysphonia–Botox chemodenervation.