Autologous Adipose Tissue Injection of Vocal Cords in Presbyphonia

Abstract

Objective This series evaluates the long-term results of autologous adipose injection (AAI) in patients older than 65 years with presbyphonia. Study Design Retrospective cohort study. Setting Academic secondary medical center. Methods This was a retrospective study with a minimum follow-up of 12 months. All patients underwent AAI for atrophy of both vocal folds due to presbyphonia. We measured subjective parameters as Voice Handicap Index–10 (VHI-10) or GRBAS scale (grade, roughness, breathiness, asthenia, strain) and objective measures such as maximum phonation time (MPT) or square pixel closure defect. We reviewed the medical records of patients undergoing AAI during the 2011-2018 period. An analysis of the demographic variables of the group was performed, as well as the values of VHI-10, GRBAS, and MPT, and the minimum closure defect measured in square pixels and the number of closed frames in the glottal cycle before and after the intervention. Results At 12 months, 17 of 18 patients reported subjective and VHI-10 improvement. The mean preoperative VHI-10 (26.7) was significantly higher than the postoperative value (14.4), and the GRBAS scale had a preoperative mean of 8.7 and a postoperative mean of 4.3, both with statistical significance. MPT increased from 7.7 to 12.4 seconds ( P < .0001). The minimum closure defect measurements obtained in square pixels changed from 305 to 124, achieving complete closure in 3 patients. The closed phase of the glottal cycle change from 14.3% to 38.2% after the AAI. Conclusions AAI improves long-term vocal fold closure, demonstrating utility in patients with presbyphonia.

The Elderly Voice: Mechanisms, Disorders and Treatment Methods

“…Kwon et al ( 48 ) reported that 12 months after injection laryngoplasty with calcium hydroxyapatite, patients showed improvement in both subjective and objective voice measurements. González-Herranz et al ( 49 ) found that elderly patients treated with autologous adipose tissue for presbyphonia had improvement in Voice Handicap Index-10 outcomes, maximum phonation time, and GRBAS scale during a mean 22.89-month follow-up. Another method, as a durable treatment option, for glottic incompetence is type I (medialization) thyroplasty which needs to be performed in an operating theater under local anesthesia in patients with larger glottic gap or those who did not sufficiently benefit from voice therapy or injection laryngoplasty ( 8 , 47 ).…”