Objectives/Hypothesis The current gold standard of therapy for adductor spasmodic dysphonia (AdSD) is injection of botulinum toxin A (BTX) in the adductor musculature. A surgical procedure could potentially offer more stable and long‐lasting voice quality. In this study, we report the long‐term results of endoscopic laser thyroarytenoid (TA) myoneurectomy versus BTX treatment in the same patients with AdSD. Study Design Retrospective case series. Methods Between July 2013 and September 2016, a total of 22 patients with AdSD were included. Voice outcomes were measured using the Voice Handicap Index and a Likert‐scale patient‐reported voice questionnaire. Data were obtained for each patient at four time points: preoperatively with and without BTX and twice postoperatively at 3 months (short term) and 12 months (long term). Results No statistically significant differences were found between voice outcome after BTX injection and the short‐ and long‐term postoperative voice outcomes for the group as a whole. During postoperative follow‐up, 10 of the 22 patients (45%) needed a second procedure after an average of 18 months (interquartile range, 13–22 months) due to recurrence of their original voice problem. Conclusions The TA myoneurectomy showed encouraging results, comparable to BTX after follow‐up of 12 months for the group as a whole. However, after good results initially, voice deterioration was seen in 45% of the patients who all underwent a second procedure. These preliminary results provide important insights into the value of TA myoneurectomy as a potential definite treatment for a select group of patients with AdSD. Further research might explore long‐term results after revision surgery. Level of Evidence 4 Laryngoscope, 130:741–746, 2020