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Authors' Response to 'Comment on 'Managing Botulinum Toxin A Dosing for Laryngeal Dystonia'
Letter/Communication

Authors' Response to 'Comment on 'Managing Botulinum Toxin A Dosing for Laryngeal Dystonia'

Pelin Yuksel, Katherine D. Mullen, Kathryn A. Mozzochi and Robert T. Sataloff
Journal of voice
10 Nov 2025
DOI: https://doi.org/10.1016/j.jvoice.2025.10.022
PMID: 41219091

Abstract

We appreciate the concerns and insights expressed in the letter to the editor. While the issues raised are appropriate, many are not relevant to our report because all diagnoses were made and all procedures were performed by the senior author (Robert Thayer Sataloff). Although the cases span over two decades, the senior author had already been caring for laryngology patient's for two decades prior to that time. As a quaternary care laryngologist, he has always included unusually comprehensive testing and strict diagnostic criteria.1 Injections throughout the period were performed with laryngeal electromyography (EMG) guidance, and all EMG machines (diagnostic and handheld) are in excellent condition and calibration. The senior author is familiar with laryngeal EMG performance and interpretation, 2 and used precision muscle targeting in patients long before the first patient in the series reported. Consequently, the issues raised by Dhana et al were not relevant to this paper because of the long-term consistency in treatment, treatment by a single laryngologist, and the absence of "changing operator practices" for this patient cohort. They might well have been relevant if this study had included patients treated by multiple physicians. Nevertheless, they are correct in highlighting the potential value of a prospective study.

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