Emily Hearn was in her St. Charles church, practicing with the choir, when her voice started to crack.
"All of a sudden, I couldn't sing," said Hearn, who has a rare neurological disorder that produces vocal cord spasms. "I was dropping my words. I couldn't carry a tune. It was awful."
The disorder, which made it sound as if she were choking on her words, disrupted Hearn's life for more than a decade until she discovered that a toxin often associated with airbrushed fashion models could help restore her voice. Months ago, a doctor stuck a long needle in her throat and released Botox into her vocal cords. The effect was dramatic.
My tremors are gone," said Hearn, 74.
Developed during World War II as a biological weapon, Botox has gained much notoriety since the federal government approved its cosmetic use in 2002. More prevalent but less widely known, however, is the therapeutic use of the toxin to treat spasms of the neck, face and vocal cords, a condition known as spasmodic dysphonia.
A growing number of patients are turning to it for relief, experts say.
At the Bastian Voice Institute in Downers Grove, nearly 500 patients from across the Midwest regularly receive Botox injections for the condition, one of the largest caseloads in the country. By paralyzing the pathway between the nerve and vocal cords, the toxin can rid the voice of spasms for nearly four months at a time.
"It's been tremendous," said Christy Ludlow, a researcher at the National Institutes of Health who has studied the disorder. "Botox has made a huge difference."
Large quantities of Botox can cause a rare disease that leads to respiratory failure, paralysis and death. But in diluted amounts, the toxin can be a safe way to stop spasms and smooth wrinkles.
Last week, the Federal Drug Administration announced that it was reviewing a small number of cases in which people became seriously ill or, in one case, died from Botox procedures. Dr. Russell Katz, director in the agency's division of neurology products, said none involved injections in vocal cords. In most of the cases, Botox was injected into the limbs of cerebral palsy patients to treat spasms, he said.
The FDA has not approved the use of Botox for spasmodic dysphonia because the maker of the drug won't fund the necessary clinical trials for such a narrow use. But the body of research showing the safe, positive effects is so large that Medicare and insurance companies now cover the cost of the procedure -- up to $900 an injection.
The first person to use the drug for that purpose was Andrew Blitzer, a professor of ear, nose and throat medicine at Columbia University. In 1984, he and other doctors were conducting clinical trials of Botox to see how well it worked for spasms of the eyelid, face and neck.
A patient undergoing treatment for an eyelid spasm also suffered from spasmodic dysphonia. Thrilled with its effect on his eyelids, he demanded that Blitzer inject Botox into his vocal cords.
It took two injections, but eventually the Botox stripped the tremors from the patient's voice. When the FDA approved Botox treatment for other spasmodic disorders in 1989, several other doctors across the country began using it on vocal cords.
Among them was Robert Bastian, the go-to doctor for Chicago-area opera singers. He first provided the treatment at Loyola University Medical Center before starting his private practice, the Bastian Voice Institute.
He said he has performed Botox injections on nearly 1,500 patients who suffer from spasmodic dysphonia and other voice disorders. In the majority of cases, their voices improved, he said.
Recently, Christine O'Connor was sitting in front of Bastian, her head tilted back, awaiting her 22nd treatment.
After injecting an anesthetic into her neck, the doctor stuck in the needle of Botox, angling first to the right, then to the left. Seconds later, the procedure was over.
"That was a good one," said O'Connor, a graphic designer from Carol Stream. "I didn't feel a thing."
When spasmodic dysphonia first attacked O'Connor's vocal cords nearly 18 years ago, she stopped socializing. Her voice sounded choppy, no matter how many cough drops she consumed.
It wasn't until she stumbled upon a description of spasmodic dysphonia on the Internet that she realized Botox might help.
After her first injection, her former voice returned. So did her spirit.
"It restored my confidence," she said.
Hearn, blessed with a gift for gab, spiraled into depression after the disorder forced her to give up favorite activities such as leading church retreats and talking with friends on the phone. She even considered learning sign language.
With the injections, her vocal life is returning to normal.
"I feel like myself again," Hearn said.
As is the case with all Botox treatments, there is a possibility for complications -- such as sucking liquid or food into the lungs, difficulty swallowing and pneumonia, experts said.
Public Citizen, a watchdog group in Washington, D.C., is calling for the drug to carry a black-box warning and for doctors to give patients pamphlets describing symptoms of illnesses that can arise.
"People need to be aware of what the adverse effects can be," said Sidney Wolfe, Public Citizen's director of health.
Bastian said there were some complications when he started providing Botox injections. But he said that more precise doses have eliminated the negative side effects and that a warning label was unnecessary.
"That is a dramatic overreaction," Bastian said. "This is a very safe procedure."