Introduction/Aim: Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is conventionally treated by speech pathology intervention (laryngeal retraining). In people who do not respond, vocal fold botulinum toxin injection is an emerging option. However, treatment responses have not been adequately characterized and long-term outcomes are not reported. We assessed a cohort of patients with verified VCD/ILO who had undergone speech therapy without improvement, then received botulinum toxin and undergone long-term follow up. Methods: We audited the Monash VCD/ILO MDT clinic from 2011-2024. Demographic and response data were ascertained by chart review and follow up was augmented by direct patient enquiry. Symptoms were assessed using the VCD-Questionnaire (VCDQ) and patients were considered in remission if physician assessment and patient report both indicated suppression of symptoms. Analyses were done using standard statistical methods. Results: All patients had persistent ongoing symptoms despite speech therapy. VCDQ scores at baseline were 48.5+/-7.0 (mean+/-SD). 29 patients (8 M, 21 F, mean age 51.3+/-15.1 years) had received botulinum toxin for a total of 103 injections (median 2 injections, IQR 1, 4.5) and underwent follow up for a total of 203 patient-years. VCDQ scores after injection (assessed at 3 months) were 45.1±9.5. versus baseline this represented a trend towards improvement of 3.4±9.1 (p=0.08, paired t-test). Two patient trajectories were observed: 9/29 (31%) patients required only 1 injection, the other 20/29 (69%) cases needed 2 or more injections. In 9 patients with a single injection, median time of remission (during the study period) was 195.54 weeks (IQR 91.47, 260.7). In the other 20 patients, the median duration of remission was 23.91 weeks (IQR 16.11, 52). No aspiration or other significant side effects were observed. Conclusion: Botulinum toxin can provide long term symptomatic relief of refractory VCD/ILO. Controlled studies are required.