Spasmodic Dysphonia Patients’ Perception of Pain with Botulinum Toxin Injections  

Amanda Hu, MD | Northwell Health

Dr. Amanda Hu is a recipient of the 2023 Dysphonia International Research Travel Award in partnership with The Voice Foundation. Dr. Hu participated in the 2023 Voice Foundation Conference and presented research entitled, “Spasmodic Dysphonia Patients’ Perception of Pain with Botulinum Toxin Injections.”

When asked what it meant to be able to attend the 2023 Fall Voice Conference, Dr. Hu stated it “enabled me to network with colleagues internationally.  Since I work and live in Vancouver, Canada, there are extra barriers to attend.” Dr. Hu also hopes that her research will assist patients by “alleviating the patient’s perception of pain, which may lower a barrier for spasmodic dysphonia patients to access the treatment option of botulinum toxin injections.”

Below is an abstract of Dr. Hu’s podium presentation.


Additional Authors: Richard Heyes MD; Charles H. Adler MD, PhD; Claire Yee PhD; David G. Lott MD

Objectives: To evaluate spasmodic dysphonia patients’ perception of pain associated with laryngeal botulinum toxin (BTX) injections and to determine factors associated with higher pain scores relative to other included patients. 

Methods: Prospective cohort study. Adult patients with adductor spasmodic dysphonia that presented to a tertiary laryngology practice for BTX injections were recruited from March to July 2022. Patients completed the visual analog scale (VAS) pre-procedure to quantify predicted pain. Ten minutes post-procedure they completed VAS and the short form McGill Pain Questionnaire (SF-MPQ). Factors that may affect pain were extracted from charts. Descriptive statistics, univariate, and multivariate analyses were conducted (alpha = 0.05). 

Results: One hundred and nineteen patients were included (63 +/- 14 yo, 26% Male). SF-MPQ reported mild pain (4.12 +/- 4.05 out of 45) with a pain intensity of none to mild (0.70 +/- 0.89 out of 5). Bilateral injections yielded significantly higher SF-MPQ scores (5.19 +/- 4.66) than unilateral injections (3.30 +/- 3.30) (p = 0.012). There was a significant VAS reduction  from pre 28.9 +/- 24.6 mm (out of 10 mm) to post 24.5 +/- 22.3 (p < 0.001). On multiple regression analyses, receiving a bilateral injection significantly (p < 0.05) contributed to a model that predicted higher pre-VAS (p = 0.013). Bilateral injections (p < 0.05) and higher VHI-10 (p < 0.05) contributed to a model that predicted higher total SF-MPQ (p = 0.001) and affective  SF-MPQ (p = 0.001) scores. Not being a professional voice user (PVU) significantly (p < 0.05) contributed to a model that predicted higher post-VAS (p = 0.008) scores. 

Conclusions: BTX injections were well tolerated with low pain scores. Factors associated with higher relative predicted or experienced pain included bilateral versus unilateral injection, PVU status, and higher VHI-10.

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Sponsoring Organizations

The Fall Voice Conference is designed to encourage and educate professionals on a multi-disciplinary approach to the management of vocal disorders. The focus of this conference is the clinical care of patients with voice-related difficulties and how clinical and basic science research guide clinical care. For more information:

Dysphonia International is dedicated to improving the lives of people with spasmodic dysphonia and related voice conditions through research, education, awareness, and research.