Bilateral trial vocal fold injection with hyaluronic acid in patients with vocal fold atrophy with or without sulcus

Abstract

Purpose To evaluate the outcome of bilateral trial vocal fold injection (VFI) with hyaluronic acid in patients with vocal fold atrophy ± sulcus and to assess the predictive value of trial VFI on the outcome of durable medialization procedure. Methods Voice data collected according to a standardized protocol before and one month after trial VFI of 68 patients with vocal fold atrophy (30) and atrophy with sulcus (38) were analyzed. Voice Handicap Index (VHI)-30 was compared to the outcome of a durable medialization at 3 and 12 months. Results The overall VHI-30 improvement was 16.8 points (from 49.9 to 33.1), which was statistically significant and clinically relevant. 57.8% of the patients experienced enough subjective benefit after trial VFI to undergo durable medialization. Of the patients that experienced subjective benefit 62% had a clinically relevant improvement in VHI-30. There was no relevant change in other parameters and no difference between ± sulcus. After durable medialization 90–94% of the patients had VHI-30 scores similar to or better than post-trial VFI. Conclusion The majority of patients experience subjective improvement after bilateral trial VFI indicating that medialization is a valid treatment option for patients with vocal fold atrophy ± sulcus. The VHI-30 only partially overlaps with patients’ subjective evaluation and does not predict which patients will experience subjective improvement. It is, however, predictive for VHI-30 outcome after durable medialization. The aerodynamic and acoustic parameters showed no relevant change. Further identification of voice assessment parameters accurately reflecting the subjective experience of these patients is warranted.

Therapeutic Efficacy of Basic Fibroblast Growth Factor in Patients With Vocal Fold Atrophy

“…16 Type 1 thyroplasty requires a percutaneous incision and is more invasive than vocal fold injection. The injection of bFGF was simple and, as shown in Table I, [17][18][19] satisfactory improvement was observed even when compared with other injections.…”

Long-term outcomes of bilateral medialisation thyroplasty in patients with vocal fold atrophy with or without sulcus

“…In this study we used different subjective voice parameters, and in line with our study on trial vocal fold injection, we noticed only a partial overlap in these subjective voice parameters. 22 Therefor the question remains if the Voice Handicap Index, the main outcome measurement instrument used in this study, is valid and precise enough for this specific population of patients and what outcome measurement instrument would be the best alternative. We therefore again stress the need for further research on the most appropriate voice-outcome measurement instruments in this group of patients.…”

Vocal fold sulci – what are the current options for and outcomes of treatment?

“…Woo and Murray found that platelet-rich plasma injection laryngoplasty improved voice quality temporarily, stroboscopic findings, and objective voice analysis outcomes in patients with vocal fold scar, sulcus and atrophy [39]. Similarly, Van den Broek et al showed a statistical, clinical and subjective improvement in voice and scores after bilateral injection laryngoplasty with hyaluronic acid in patients with vocal fold atrophy and sulcus vocalis [40]. Interestingly, they found the VHI-30 score obtained after the vocal fold injection to be a predictive value of the VHI-30 score outcome after a long-lasting medialization procedure.…”