Botox (botulinum toxin) injection is one of the most effective treatments for spasmodic dysphonia, a voice disorder caused by involuntary spasms of the vocal cords during speech. It’s also used for laryngeal spasm or paradoxical vocal fold motion, where the vocal cords close when they should be open, causing breathing difficulty or noisy breathing. Botox gently weakens overactive muscles to reduce spasms and restore more natural voice or breathing.

The injection is done in the office under local anesthesia. A small needle is carefully guided into the vocal fold muscle through the neck, using a combination of electromyography (EMG) or endoscopic guidance. Most patients say the procedure is brief and tolerable — lasting about 15–20 minutes from start to finish. You may notice temporary breathiness, a weaker voice, or mild swallowing difficulty for a few days, but this usually improves within 2 weeks. The therapeutic effect begins after 3–7 days and lasts around 3–4 months, at which point repeat injections are typically scheduled. Botox is extremely effective for managing symptoms and has helped thousands of patients regain control of their voice and breathing with minimal risk.

A superior laryngeal nerve block is a quick, in-office procedure for treating chronic throat pain, laryngeal hypersensitivity, chronic cough, and vocal fold spasms. This nerve can become irritated or inflamed due to reflux, viral illness, or nerve trauma, leading to symptoms like throat tightness, sharp pain with speaking, or uncontrollable coughing. A nerve block interrupts this overactive signal pathway, offering both relief and diagnostic information.

The procedure takes about 10 minutes and is done while you're seated in the exam chair. After numbing the skin, a small injection of local anesthetic (sometimes combined with steroid) is placed near the nerve through the front of the neck. Most patients report only mild discomfort — like a pinch or pressure — and relief can be almost immediate or occur over several days. You may feel a temporary numb sensation in the throat or voice weakness for a few hours. Results may last days to weeks; for some, one block is enough, while others may need a series of injections spaced apart. Risks are very low and include brief voice changes or mild swelling at the injection site. The benefit is often dramatic, especially for cough and throat pain that hasn't responded to other treatments.

Steroid injection is a targeted treatment used to reduce inflammation, swelling, and scarring in the vocal folds or airway. It’s most commonly used for vocal fold scarring (which can cause hoarseness or a tight-sounding voice) or subglottic stenosis (narrowing just below the vocal cords that may cause breathing symptoms). Injecting a small dose of corticosteroid directly into the affected area can soften scar tissue and reduce swelling, improving both voice and airflow.

The procedure is performed in the office with a flexible or rigid laryngoscope. After numbing the throat and nose, the doctor uses a thin needle passed through the scope or neck to deliver the medication precisely where needed. The injection takes about 10–15 minutes and is generally well tolerated — patients may feel pressure or brief discomfort but usually no significant pain. You can return to work or normal activities the same day, although voice rest for 24 hours is often recommended. Most patients begin to notice improvement within days to a week. You may need one or more injections over time, depending on your condition. Risks are very low and include temporary irritation or minor voice changes.

Hyaluronic acid is a naturally occurring gel-like substance that can be injected into the vocal folds to treat vocal fold atrophy (thinning), paresis (weakness), or paralysis. These conditions can lead to a breathy or weak voice, difficulty projecting, or vocal fatigue. The injection aims to bulk up the vocal fold, improve closure, and restore a stronger, more efficient voice.

This procedure is done in the office using a flexible scope and local anesthesia. The vocal fold is visualized with a camera, and a fine needle injects hyaluronic acid through the mouth or neck. The injection takes about 15–20 minutes. Some patients may feel a brief pinch, fullness, or urge to cough, but the procedure is usually well tolerated. You may be advised to rest your voice for a day, but normal speaking usually resumes quickly. The improvement is often immediate or noticed within a few days. Results typically last 3–6 months, though some patients experience more extended benefits. For long-term results, repeat injections or fat transfer may be considered. Risks are minimal and include temporary hoarseness or instability in the voice as the material settles.

PRP (Platelet-Rich Plasma) injection is a regenerative treatment that uses a patient's blood to stimulate vocal fold healing. It's beneficial for treating vocal fold atrophy, scarring, and sulcus vocalis — a groove or depression in the vocal fold that can cause a weak, breathy, or strained voice. PRP contains concentrated growth factors that promote collagen remodeling, reduce inflammation, and help restore pliability to the vocal tissue.

The procedure is done entirely in the office. A small amount of your blood is drawn and processed in a centrifuge to separate the PRP. Then, using a flexible scope for guidance, the PRP is injected into the vocal folds through either the mouth or the neck. The full appointment takes about 45–60 minutes, with the injection itself lasting only 10–15 minutes. Most patients describe the sensation as a brief fullness or mild pressure. Some localized pain at the injection site may be expected. Voice rest is usually recommended for 24–48 hours, with a gradual return to speaking afterward. Depending on the condition, a series of 1–3 treatments may be suggested. Because it's your own tissue, there's virtually no risk of allergic reaction. PRP is a safe, natural option that may be combined with voice therapy or other injections for longer-lasting results. 

Below, you can hear two Before and After PRP injection samples.

Sample 1

Sample 2

Nanofat injection is a next-generation vocal fold treatment that uses highly refined fat from your own body — processed to retain powerful healing factors while removing the bulkiness of traditional fat. It’s used to treat vocal fold atrophy and paresis (weakness), especially in patients seeking natural, regenerative options to restore fullness and elasticity to the voice.

The procedure starts with a small amount of fat gently harvested from an area like the abdomen or thigh — often using a mini-liposuction technique. The fat is then emulsified into a smooth, injectable form rich in stem cells and regenerative proteins. In the same visit (or occasionally a follow-up), the nanofat is injected into the vocal folds using a flexible laryngoscope and fine needle. The process takes about 60–90 minutes total. Most patients tolerate it well, with only minor soreness at the donor site and a full sensation in the throat for a day or two. Voice rest is usually recommended for 2–3 days. Results are often longer-lasting than those of synthetic fillers, and many patients notice gradual improvement in strength, range, and clarity over several weeks. This procedure is low-risk, with the added benefit of using your own tissue for natural, biocompatible healing.

Microfat injection is a well-established technique for treating vocal fold atrophy and paresis, particularly when more lasting volume restoration is needed. Unlike nanofat (which is processed to remove fat cells), microfat preserves whole fat cells, providing both bulk and regenerative support. It's ideal for patients with longstanding hoarseness, voice fatigue, or breathy voices looking for a natural, long-term solution.

A small amount of fat is harvested from your abdomen or thigh under local anesthesia. After light processing to remove excess fluid, the fat is injected into the vocal fold muscle using a fine needle under endoscopic guidance. The procedure takes around 60–90 minutes from start to finish. There may be slight swelling or soreness at both the donor site and the throat for a few days. Voice rest for 3–5 days is usually recommended to help the fat "settle" and integrate into the tissue. Results can last a year or longer, though touch-up procedures may occasionally be needed. Because it's your own fat, there's no risk of allergic reaction. The benefits include improved vocal strength, less fatigue, and a more stable voice — particularly for those whose voice has changed with age or after surgery.

Vitrase (hyaluronidase) is an injectable enzyme medicine that helps break down excess fluid or gel-like substances in the body. It works by gently loosening the natural bonds in tissue, allowing trapped blood or injectable materials to be reabsorbed more efficiently. In the office, Vitrase is delivered through a fine needle directly into the vocal fold under precise visualization. The procedure is done under local anesthesia.

In laryngology, Vitrase has three primary uses. It can help resolve a vocal fold hemorrhage by speeding up the clearance of blood from the tissue, reducing swelling, and allowing the vocal folds to vibrate more normally again. It can be used in patients with smoker's polyps, called Reinke's edema, to reduce the swelling without traditional surgery. It is also valuable in adjusting previous vocal fold augmentations, such as Restylane injections, when a touch-up is needed due to over-injection of Restylane. In these cases, Vitrase allows your laryngologist to carefully soften or reshape an injection, restoring balance and improving vocal quality without having to remove or redo the entire procedure.