{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:59:58Z","timestamp":1791935998651,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,12,24]],"date-time":"2018-12-24T00:00:00Z","timestamp":1545609600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>Although no clear guidelines exist, protocols in the treatment of spasmodic dysphonia (SD) vary among physicians. Previously published work comes from relatively few centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>A descriptive survey among experts (laryngologists who practice Botulinum toxin injections for SD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An online 58\u2010item survey was sent to all otolaryngologists who self\u2010identify as laryngologists on the American Academy of Otolaryngology\u2013Head and Neck Surgery website. Items surveyed included botulinum toxin injection technique, laterality, and dosage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>An 80% response rate was achieved (70 completed the survey). Participants collectively reported treating &gt;4,000 SD patients in the past year (mean, 71\u2009\u00b1\u200968 patients\/laryngologist). Eighty\u2010seven percent perform injections exclusively in the office; the remainder both in the office and operating room. For adductor SD injections, 88% use electromyographic (EMG) guidance alone via cricothyroid approach. The remainder use anatomical landmarks alone (9%) or EMG with endoscopic guidance (3%). Sitting is the preferred patient position (70%; supine, 30%). A substantial majority (87%) begin with bilateral injections (starting dosage mode, 1.25 units\/side). For abductor SD injections, 67% use EMG guidance alone and 31% use endoscopic guidance with or without EMG. Sitting is the preferred patient position (84%; supine, 16%). The preferred approach is anterior\u2010translaryngeal (51%), followed by lateral\u2010retrolaryngeal with rotation (34%). A considerable majority (79%) begin with unilateral injections (starting dosage mode, 5 units). When deciding on initial dosage, the most influential factor was balancing patients' desire\/needs, followed by patients' frailty and risk of aspiration. The typical planned interval between injections is 3 to 4 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Laryngologists follow fairly uniform protocols in the treatment of SD with some important and previously unpublished differences. This study documents areas of agreement and discordance among laryngologists in the United States for the treatment of SD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4<\/jats:p><jats:p><jats:italic>Laryngoscope<\/jats:italic>, 129:1650\u20131656, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27696","type":"journal-article","created":{"date-parts":[[2018,12,24]],"date-time":"2018-12-24T14:12:04Z","timestamp":1545660724000},"page":"1650-1656","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Common practices in botulinum toxin injection for spasmodic dysphonia treatment: A national survey"],"prefix":"10.1002","volume":"129","author":[{"given":"Hagit","family":"Shoffel\u2010Havakuk","sequence":"first","affiliation":[{"name":"the Department of Otolaryngology\u2013Head and Neck Surgery Rabin Medical Center  Petah Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel\u2010Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Rosow","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Miami Miller School of Medicine  Miami Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian X.","family":"Lava","sequence":"additional","affiliation":[{"name":"USC Voice Center, Department of Otolaryngology\u2013Head and Neck Surgery University of Southern California  Los Angeles California U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edie R.","family":"Hapner","sequence":"additional","affiliation":[{"name":"USC Voice Center, Department of Otolaryngology\u2013Head and Neck Surgery University of Southern California  Los Angeles California U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Michael M.","family":"Johns","sequence":"additional","affiliation":[{"name":"USC Voice Center, Department of Otolaryngology\u2013Head and Neck Surgery University of Southern California  Los Angeles California U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,24]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2009.08.003"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25273"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215111000739"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2014.08.011"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813484685"},{"key":"e_1_2_6_7_1","first-page":"622","article-title":"Current practices in the management of adductor spasmodic dysphonia","volume":"39","author":"Eskander A","year":"2010","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1516-18462013005000034"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25551"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1746-160X-5-20"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.56.5.526"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348940111000503"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2005.03.008"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892-1997(02)00080-2"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26265"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.17226\/13058"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20855"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21395"},{"key":"e_1_2_6_19_1","first-page":"59","article-title":"The swallowing side effects of botulinum toxin type A injection in spasmodic dysphonia","volume":"12","author":"Buchholz DW","year":"1997","journal-title":"Dysphagia"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.2165\/11599840-000000000-00000"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flary.27696","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.27696","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T09:00:45Z","timestamp":1734685245000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.27696"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,24]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1002\/lary.27696"],"URL":"https:\/\/doi.org\/10.1002\/lary.27696","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,24]]},"assertion":[{"value":"2018-05-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}