Can Botox injections cause a raspy voice. If so, what can I do to regain my voice?

Question

I received Botox for migraine approx. 6 months ago. One in jection was on the right side of my neck below my ear canal about halfway down the neck. I'm worried that that neck injection caused the raspy voice, as I didn't have a raspy voice prior to Botox. I hope there is a treatment to fix this vocal issue, as it has gotten worse with the colder weather.

Richard A. Bartlett, MD · Answer

Dear 72517,Thank you for your question. It is highly unlikely that botox would cause your voice to become raspy. Especially because the botox would have worn off by now as it has been six months. I suggest following up with your primary care physician and expressing your concerns. Best of luck to you!

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your raspy voice.  Unfortunately I do not think your botox treatment is the likely cause of the change in your voice and I would favor seeing an ENT doctor for an in-person evaluation.

Jason Emer, MD · Answer

It is unlikely that Botox caused this. After 6 months, your Botox results would have resolved. If it persists, I recommend following up with your Doctor. Best, Dr. Emer

Anthony P. Terrasse, MD · Answer

Thank you for your question. While extremely rare, Botox can cause dysphonia, or a raspy voice. That being said, there are a myriad of other causes that are much more likely to be the culprit. First, it is unlikely that the injection penetrated deeply enough in your neck to reach the nerves of the voice box. Second, any reported issues with dysphonia as a result of Botox resolve no more than three months after the injection. As it has been six months, it’s very unlikely that Botox is at the root of your voice issue. My best advice would be to see your general practitioner or schedule a consultation with an ENT. They can examine you and work to discover the cause of the raspiness. Best of luck.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question 72517g. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam where the entire medical history is reviewed. However, I hope the information provided here is useful.Botox works to treat migraine headaches in the same way it works to treat wrinkles: by relaxing muscles. In the case of migraine headaches (and sometimes other headaches such as tension headaches) the muscles in the upper face and head contract. This puts pressure on the bones which can be very painful.  Botox will relax the muscles to relieve the pain. The areas treated with Botox for migraine headaches are those treated in the upper face. Sometimes additional muscles are also treated with Botox such as those in the temples and back of the head. The dose of Botox used is in the range of 60 to 70 units. Full results are seen in two weeks and after a Botox treatment. However, many patients feel improvement as early as the next day after a Botox treatment.  Botox treatment for migraines will significantly reduce the frequency of migraines and is a great alternative for those for whom oral medications are ineffective. Most people enjoy their results from a Botox treatment for three to four months. At that time a maintenance treatment is recommended.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.It is unlikely that Botox is a cause of a raspy voice. It is not specified whether the raspy voice began immediately after the Botox treatment or six months later. I assume it started six months later. If I had a patient with the concern described here I would recommend speaking with her general physician.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck

Selena Lantry, MD · Answer

It is unlikely that Botox in your neck caused a raspy voice.  Botox is a purified protein that deteriorates over time.  If you have had a raspy voice for 6 months, you should consider seeing an ENT doctor for an evaluation.

Christopher R. Macdonald, FRCS(Plast) · Answer

Thanks for the question. 
Although BOTOX can cause dysphonia, this is incredibly rare. I would also expect any such problems caused by BOTOX to have settled in by 3-4 months. 
There are lots of causes of dysphonia and I would strongly urge you to see your primary care physician for an urgent assessment.
Good luck!
Dr. Chris Macdonald
CRM Aesthetics

William Marshall Guy, MD · Answer

Hello 72517g,If you received Botox into the neck muscles on the side, the chance of Botox causing a raspy voice is very low.  In fact, Botox anywhere in the neck when done properly has a minimal risk of changing the voice given how deep the nerve is that controls the voicebox.  However, if on the slim chance that was the cause, it would have resolved within 3 months of the injection.  You noted your Botox injection for migraines was over 6 months ago.  At this point it could not be Botox.  Therefore, I would recommend you follow up with your doctor for an evaluation to determine why you have the worsening voice, as this can be the sign of something serious.I hope this helps and good luck.

Benjamin C. Paul, MD · Answer

Raspy voice, also known as dysphonia, has over 80 possible causes.  That being said, dysphonia been described after neck botox. It is theoretically possible for the botox to travel into the larynx (voice box). That being said, this is VERY rare.  Also, it tends to resolve in 3 months.  It is possible you have another reason that your voice is raspy. I would see an ENT doctor who can scope you and visualize your vocal cords. Best of luck!

Monika Soni, MD · Answer

Thank you for your question. It is unlikely that Botox has caused your symptoms. This is most likely an upper respiratory infection or allergies. I recommend having a consultation with you primary care physician for an evaluation and treatment. Best of Luck!

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