Download free patient information

Injection laryngoplasty is a procedure used to improve the voice or help with swallowing by injecting a substance into one or both vocal cords (also called vocal folds). This helps them move closer together and improves their function.

You may be offered injection laryngoplasty if:

• Your voice is weak, breathy, or hoarse
• You have difficulty swallowing due to one vocal cord not closing properly
• You have a vocal cord that is not moving (vocal cord palsy or paralysis)
• You’ve had recent throat surgery, and your vocal cord position needs adjusting

This procedure is done while you are awake, using local anaesthetic (numbing medicine).
Here’s what you can expect:

1. Numbing your throat:
   A local anaesthetic will be sprayed into your nose and throat to make the procedure more comfortable.
2. Accessing the vocal cords:
   A thin camera (flexible endoscope) will be passed through your nose to view the vocal cords.
3. Injection:
   A small needle will be inserted either through the neck or mouth to inject a substance (like hyaluronic acid, collagen, or another filler) into the vocal cord. This pushes the cord into a better position to help it close properly.
4. Voice checks during the procedure:
   You may be asked to speak so the doctor can check your voice and make sure the injection is helping.

The entire procedure usually takes about 20–40 minutes, and you can typically go home the same day.

Most patients report only mild discomfort. The anaesthetic numbs the area well, but you might feel:

• A slight pinch or pressure during the injection
• Mild soreness or irritation in the throat for a few hours after

• Improved voice strength and quality
• Easier swallowing with less risk of food or drink going the wrong way
• Less breathlessness while speaking
• Often avoids the need for more invasive surgery

Like all medical procedures, injection laryngoplasty carries some risks, but serious complications are rare. Possible side effects include:

• Temporary discomfort or bruising at the injection site
• Coughing or mild throat irritation
• Temporary change in voice quality (which usually improves)
• Swelling or infection (rare)
• Allergic reaction to the injected material (very rare)

Your doctor will discuss any specific risks based on your medical history.

• You can usually eat and drink after 1–2 hours once the numbness wears off.
• Voice rest may be advised for a short time (your doctor will tell you).
• Avoid strenuous activity for 24 hours.
• Your voice might sound strange or rough at first but should improve over a few days.

The effect of the injection can vary depending on the material used:

• Temporary fillers may last 3 to 6 months
• Longer-lasting materials may last 12 months or more
• In some cases, repeated injections or surgery may be recommended

Contact your doctor or go to A&E if you experience:

• Difficulty breathing
• Increasing pain or swelling in the throat
• Fever or signs of infection
• Bleeding from the mouth or throat

Q: How long will the effects last?
A: Depending on the material used, results may last from three to eighteen months. Some patients may require repeat injections.

Q: When can I return to work?
A: Most patients can return to work within a day or two, depending on the nature of their job and voice usage.

Q: Can I eat and drink normally after the procedure?
A: Yes, but start with soft foods if your throat feels sore. Avoid very hot or spicy foods for the first 24 hours.

Laryngeal dystonia (also known as spasmodic dysphonia) is a rare voice disorder caused by involuntary spasms in the muscles of the voice box (larynx). These spasms can cause your voice to:

• Sound tight, strangled, or broken (adductor type)
• Sound weak and breathy (abductor type)
• Fluctuate between both (mixed type)

Laryngeal dystonia can significantly affect how you communicate, but there is effective treatment available.

Botulinum toxin is a purified protein that temporarily relaxes overactive muscles. It’s commonly used in both medical and cosmetic treatments.

In laryngeal dystonia, very small amounts of botulinum toxin are injected into specific muscles of the voice box to reduce the spasms and improve the voice.

Before the Procedure

• You may be asked to avoid certain medications (like blood thinners) before the injection — your doctor will advise you.
• You'll usually be seated or lying down comfortably.
• No general anaesthetic is needed — local anaesthetic may be used.

During the Procedure

• A small needle is inserted into the affected muscle of your larynx (usually through the skin of your neck).
• A specialist may use EMG (a machine that measures muscle activity) to guide the injection accurately.
• You may be asked to make sounds or speak during the procedure.

The procedure typically takes about 10–15 minutes, and most people can go home shortly afterwards.

It's normal to experience:

• A weak, breathy, or hoarse voice for a few days to 2 weeks
• Mild swallowing difficulties, especially with thin liquids
• Temporary changes in pitch or voice quality

These effects are expected and usually settle down as the toxin takes effect.

• Voice improvement usually begins 3 to 7 days after the injection.
• Maximum benefit is often seen by 2 to 4 weeks.
• The effects typically last  4 months — repeat injections are usually needed for ongoing benefit.

Botulinum toxin is generally very safe when used in small doses by experienced specialists. Possible side effects include:

• Temporary hoarseness or breathy voice
• Mild swallowing problems
• Sore throat or mild discomfort at the injection site
• Rarely, the injection may need to be repeated if the dose needs adjusting

Serious side effects are extremely rare.

• You’ll usually be asked to feed back to your doctor a few weeks after the injection to assess your response.
• Repeat injections are typically given every 4 months, depending on your symptoms and needs.

Please contact your doctor or clinic if you experience:

• Difficulty swallowing food or liquids that worsens
• Breathing problems
• High fever, significant pain, or swelling in the neck

You are being offered a botulinum toxin injection into the cricopharyngeal muscle to treat:

Cricopharyngeal Spasm

This is when the cricopharyngeal muscle (part of the upper oesophageal sphincter) becomes overly tight, making it hard to swallow and creating a feeling of something "stuck" in the throat.

Retrograde Cricopharyngeal Dysfunction (R-CPD)

This is a condition where the cricopharyngeal muscle doesn’t relax to allow burping. It can lead to:

• Inability to burp
• Bloating or gurgling in the chest/throat
• Abdominal discomfort
• Excessive flatulence

Botulinum toxin helps by relaxing the cricopharyngeal muscle, allowing normal swallowing or burping to occur.

Please note that this treatment for R-CPD is not currently funded by the NHS.

Botulinum toxin (BoNT-A) is a well-established medicine used to temporarily weaken overactive muscles. It’s commonly used in both medical and cosmetic procedures and is highly effective in treating muscle spasms.

This procedure is performed through the skin of the neck, using a thin needle. It is guided by EMG (electromyography), which uses electrical signals to accurately target the correct muscle.

You’ll be asked to lie on your back in a comfortable position.

• The skin on your neck is cleaned, and a small amount of local anaesthetic may be used to numb the area.
• A fine needle is inserted into the neck and guided into the cricopharyngeal muscle using EMG monitoring. You may be asked to swallow or perform small movements to help locate the muscle.
• Once the correct position is confirmed, a small amount of botulinum toxin is injected.

The entire procedure usually takes 15 to 20 minutes.

• You’ll usually be observed for a short time and then allowed to go home the same day.
• Your throat may feel a little sore or “tight” for a day or two.
• You may be advised to eat soft food for the first 24–48 hours.

If you're being treated for cricopharyngeal spasm:

• Swallowing often feels easier within 3 to 7 days.

If you're being treated for R-CPD:

• Most people begin to burp for the first time within a few days to a week.
• Bloating and gurgling typically improve significantly.

• The effects of the botulinum toxin typically last 3 to 6 months.
• Some people may need repeat injections if symptoms return.
• In cases of R-CPD, one injection may be enough to permanently “reset” the muscle for long-term benefit.

Most people tolerate this procedure very well. However, like any treatment, side effects can occur.

Common (usually mild and short-lived):

• Mild neck discomfort or soreness
• Temporary changes in swallowing (slight coughing or choking on thin liquids)
• Mild hoarseness or throat tightness

Rare:

• Difficulty swallowing solid food (usually temporary)
• Infection or bruising at the injection site
• Noisy breathing (very rare)
• Allergic reaction (very rare)

• You will usually be asked to feed back to your doctor within a few weeks to review your response to treatment. Further treatment can be planned if needed.

Please contact your doctor or attend A&E if you experience:

• Difficulty swallowing saliva or liquids persistently
• Breathing difficulty
• High fever or signs of infection
• Severe neck pain or swelling

• This is a quick, safe, and minimally invasive procedure.
• It can significantly reduce symptoms of swallowing difficulty or inability to burp.
• Most people notice improvement within a few days.
• Side effects are usually mild and short-lived.

A neurogenic cough, also known as chronic refractory cough, is a persistent cough lasting more than 8 weeks, which is not caused by infection, asthma, reflux, or other common causes. It is thought to result from heightened sensitivity or irritation of the nerves in the throat—particularly the superior laryngeal nerve.

This can lead to coughing in response to triggers such as talking, laughing, cold air, or even without any clear reason.

The superior laryngeal nerve block involves injecting a small amount of local anaesthetic, and sometimes steroid medication, near the superior laryngeal nerve in the neck. This nerve helps regulate sensation in the upper airway and throat.

By temporarily “numbing” the nerve, the block can reduce its sensitivity and break the cycle of irritation that leads to chronic coughing.

If other treatments such as cough suppressants, reflux medications, or speech therapy have not helped, your specialist may recommend a superior laryngeal nerve block. This procedure can:

• Reduce the frequency and severity of your cough
• Improve your quality of life
• Allow your throat to “reset” and reduce nerve hypersensitivity

This procedure is particularly useful when neurogenic cough has persisted despite medical and behavioural treatment.

• You will be asked to sit or lie down comfortably.
• The skin on your neck will be cleaned with antiseptic.
• The doctor will feel for a small bone in your neck (the hyoid) and use it to guide the injection.
• A fine needle is used to inject local anaesthetic (and possibly a steroid) near the superior laryngeal nerve.
• The entire procedure usually takes less than 10 minutes.

• You may notice improvement in your cough within a few hours to a few days.
• Some people experience hoarseness or a “lump in the throat” sensation—these effects usually wear off within 24–48 hours.
• You may require repeat injections, often spaced a few weeks apart, depending on how your symptoms respond.

In a recent clinical study, over 80% of patients with neurogenic cough reported significant improvement in their symptoms after superior laryngeal nerve blocks*.

* Tipton CB, Walters R, Gudipudi R, Smyre D, Nguyen S, O'Rourke AK. The Efficacy of Superior Laryngeal Nerve Block for Neurogenic Cough: A Placebo-Controlled Trial. Laryngoscope. 2023 Nov;133(11):3068-3074. doi: 10.1002/lary.30739. Epub 2023 May 11. PMID: 37166167.

While generally safe, the procedure can occasionally cause:

• Temporary hoarseness or voice changes
• Mild soreness or bruising at the injection site
• A feeling of numbness in the throat
• Rarely, allergic reaction or infection at the injection site

Serious complications are very rare. Your doctor will discuss the risks and answer any questions you may have before the procedure.

Yes. Other treatments that may be used alone or alongside SLNB include:

• Neuromodulator medications (e.g. amitriptyline, gabapentin)
• Speech and language therapy for cough suppression techniques
• Behavioural therapy to reduce cough triggers
• Botulinum toxin injections (in select cases)

Your doctor will tailor your treatment plan based on your individual needs and response to therapy.

Before your procedure, your doctor will explain the benefits, risks, and alternatives. You will have the chance to ask questions and give your informed consent.