Supraglottic Botulinum Toxin Injection Improves Symptoms of Laryngeal Sensory Dysfunction

ABSTRACT Objective Central/peripheral vagal hypersensitivity underpins laryngeal sensory dysfunction (LSD). Botulinum toxin type A (BoNT‐A) injection has emerged as a targeted treatment for modulating laryngeal sensory pathways. This study aimed to evaluate short‐term outcomes and predictors of response following supraglottic BoNT‐A injection in patients with refractory LSD. Methods Retrospective cohort study of patients undergoing supraglottic BoNT‐A injection treatment between 2019 and 2025 for LSD symptoms refractory to medical/behavioral therapy. Outcome measures included the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ), Reflux Symptom Index (RSI), Cough Severity Index (CSI), and Voice Handicap Index‐10 (VHI‐10). Pre‐ and post‐treatment scores were compared using paired statistical tests and effect size estimation. Treatment characteristics and follow‐up duration were reported, along with attainment of minimal clinically important difference (MCID) and predictors of response. Results Eighty consecutive patients (mean age 58.3 years; 48 female) showed significant improvement across hypersensitivity domains: LHQ +3.1 (95% CI: 2.4–3.8, p  p  p  p  = 0.20). MCID thresholds were achieved in 64% for LHQ and 56% for RSI. Overall, 71% of patients reported phenotypic and clinically relevant improvement. Patients with a positive short‐term superior laryngeal nerve (SLN) block were more likely to respond to supraglottic BoNT. No serious complications occurred. Conclusions Supraglottic BoNT‐A injection is a safe, effective treatment for laryngeal sensory dysfunction targeting the sensory field of the SLN to provide clinically meaningful reductions in throat irritation without compromising voice function. Level of Evidence 4.