This comprehensive review neatly summarises non-cosmetic uses of botulinum toxin within otorhinolaryngology, it is perhaps easy to forget the medical use of botulinum toxin has now been approved for the last thirty years. Its overall safety profile places it as an attractive minimally invasive treatment option in a wide range of conditions including voice disorders, facial scarring and dysphagia. The current evidence base for both injection sites and reported mean total doses are included, giving a practical overview to the treatments themselves. Spasmodic dysphonia is perhaps one of the areas where botulinum toxin use to inhibit laryngeal hyperkinesias has been well established. A key distinction is shown however between the abductor and adductor variants, with much higher rates of effectiveness demonstrated in the latter with duration of benefit between 6-15 weeks.