Interarytenoid botulinum toxin injection for recalcitrant vocal process granuloma


  • Presented at Triological Society Combined Sections Meeting, Miami Beach, Florida, U.S.A., January 26–28, 2012.

  • Research was performed at the Massachusetts Eye and Ear Infirmary, Boston, M.A., U.S.A. The authors have no other funding, financial relationships, or conflicts of interest to disclose.



This study evaluated the efficacy of botulinum toxin type A injected into the interarytenoid muscle to treat recalcitrant vocal process granulomas.

Study Design

Retrospective clinical review at a tertiary care center.


Eight patients with vocal process granulomas refractory to a variety of prior treatments including surgical resection, proton pump inhibitor therapy, and voice therapy underwent percutaneous injection of botulinum toxin type A into the interarytenoid muscle, performed in an office setting. Doses ranged from 5 U to 25 U in one to two injections.


One patient demonstrated no improvement, two patients demonstrated partial resolution, and five patients demonstrated complete resolution of their granulomas. Four patients noted transient breathiness. There were no other side effects. All patients tolerated the injections without difficulty.


Botulinum toxin injection into the interarytenoid muscle appears to be a safe and effective modality for treating recalcitrant vocal process granuloma. Laryngoscope, 123:3084–3087, 2013