Injections of Botox or another brand of botulism toxin to the vocal cords have become the go-to for helping patients with spasmodic dysphonia and vocal tremor speak more clearly.

Through decades of experience, the Vanderbilt Voice Clinic now has moved the treatment forward by identifying a continuum  that results in improved vocalization for individual  patients without excess intervention. You might call it a right-sized approach.

"Overall, we've evolved from giving fairly big doses on both sides to smaller doses, and often only on one side," otolaryngologist K. Charles Fletcher, M.D.