Treatment Speech therapists, observing such a patient strain to achieve vocalization, often assume that relief can be obtained by making the patient relax, and psychotherapists believed at first that a search of the patient’s personal life around the time when the dysphonia began would enable the patient to understand the problem and regain a normal mode of speaking. But both these methods have failed without exception. Drugs useful in the treatment of Parkinson disease and other extrapyramidal diseases are practically never effective. Sectioning of one recurrent laryngeal nerve can be beneficial, but recurrence is to be expected. The most effective treatment, comparable to treatment of other segmental dystonias, consists of the injection of 5 to 20 U of botulinum toxin, under laryngoscopic guidance, into each thyroarytenoid or cricothyroid muscle. Relief lasts for several months. Hoarseness and raspiness of the voice is also a result of structural changes in the vocal cords, the result of cigarette smoking, acute or chronic laryngitis, polyps, and laryngeal edema after extubation.
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