60-year-old male with adductor spasmodic dysphonia for many years. He does not want to have percutaneous or transoral botulinum toxin injections. Since 2022, he has been coming approx. every 3-4 months for local botulinum toxin injections via a transnasal flexible endoscopy approach into the ventricular folds, plus a small amount into one vocal fold. The office-based intervention is performed without sedation.