목적: The purpose of this study was to assess the clinical outcomes of patients with dysphagia treated with EMG-guided Botulinum toxin injection to crycopharyngeus muscle. 방법:We retrospectively reviewed the 34 patients who underwent EMG-guided Botulinum toxin injection to crycopharyngeus muscle. All patients failed to get safe diet after maximal swallowing rehabilitation. The patients with insufficient data (n=6) were excluded. Consequently, a total of 28 patients were analyzed in this study. The etiologies of dysphagia were H&N cancer in 17 patients, neuromuscular disease in 2 patients, cerebral vascular accident in 2 patients, brain tumor in 2 patients, and etc in 5 patients. All patients underwent repeated videofluoroscopic/ fiberrscopic evaluation of swallowing, and functional evaluations (dysphagia handicap index) before and after botox injection. Multiple or bilateral side botox injection was underwent in 5 patients. The mean dose of botox was 37.9 unit (range 10-50 unit). 결과:Of the 28 patients, 20 (71.4%) showed an excellent improvement in their ability to take an oral diet safely. The penetration-aspiration scale (p<0.001), NIH swallowing safety score (<0.001), the clinical symptom score (p<0.001), the disability rating scale (p<0.001), and dysphagia handicap index (p<0.001) were significantly improved after botox injection. 결론:Office-based EMG guided botox injection to the cricopharyngeus muscle is a simple, safe, and effective tool for dysphagia patients, and should be considered as definite treatment for dysphagia with various etiologies.