Current approaches to management of vocal fold scar

Abstract

Purpose of review Vocal fold (VF) fibrosis remains an insoluble problem in most cases, with a severe impact on vocal quality and effort. This review examines current investigations and research strands that explore the understanding of VF wound healing and applied treatments for the management of VF scar. Recent findings Recent work focused on VF fibrosis has examined wound healing in the glottis, fibrosis-modifying medication, and tissue engineering approaches that span cytokine and growth factor therapy, scaffold and cell delivery platforms, seeded scaffolds, conditioned media and stem cell therapy. Many show promise and may deliver improvements in the wound bed favouring less fibrogenic healing patterns, ultimately with the goal of preserving or restoring VF vibration. Further collaborative research is required that examines combined approaches, long term outcomes, better three-dimensional modelling of cell-cell interactions and delivery modalities for molecular therapies. Summary VF fibrosis research continues to expand and explore a variety of mechanistic pathways in order to understand VF healing and identify novel and complementary targets for manipulation. Many different approaches show promise and may also offer synergistic benefits. Research continues to strive for healing that more closely resembles true VF architecture and function.

In vitro evaluation of genipin-crosslinked gelatin hydrogels for vocal fold injection

“…In contrast, it has been demonstrated that the incorporation of cells or biomolecules into acellular materials, such as hydrogel, provides better retention than acellular materials 11 . Therefore, tissue engineering strategies for designing an effective biomaterial for vocal fold treatment have been highlighted to facilitate local healing and restore their native function 12 . An example is the use of mesenchymal stem cells (MSCs) or secretome encapsulation in hydrogel to promote native tissue regeneration and reduce the local immune system 13 .…”

Duration of Clinical Response After In‐Office Steroid Injection for Vocal Fold Scar

“…In 2019, the European Laryngological Society and the American Laryngological Association proposed a classification system stratifying VF scar into four types, accounting for both scar location and impact on laryngeal function; whereas a VF scar grading system was not employed in the present study, such systems may hold promise to clarify divergent patient response to VFSI based on underlying VF scar etiology and pathophysiology, and inform clinical research on the topic. 31,32 Advantages, Limitations, and Future Directions Using blinded expert ratings, our findings suggest that VFSI is associated with long-term improvement in a subset of patients; however, future higher-powered studies will be required to clarify patient factors associated with long-term improvement, maximizing the laryngologist's ability to select candidate patients, and also guide patient expectations. Limitations of this study include use of two different steroid formulations, lack of acoustic parameter analysis, suboptimal interrater reliability for various voice and LVS outcome measures, and lack of intrarater reliability testing, though the blinded rating methodology likely served to decrease observer bias.…”

“…Further, measures such as breathiness may differentially improve in patients with specific VF scar etiologies such as phonatory trauma due to divergent mechanisms of disease compared to other etiologies. In 2019, the European Laryngological Society and the American Laryngological Association proposed a classification system stratifying VF scar into four types, accounting for both scar location and impact on laryngeal function; whereas a VF scar grading system was not employed in the present study, such systems may hold promise to clarify divergent patient response to VFSI based on underlying VF scar etiology and pathophysiology, and inform clinical research on the topic 31,32 …”

5‐Aminolevulinic Acid‐Mediated Photodynamic Therapy Improves Vocal Fold Wound Healing in Rats

“…Many methods have been proposed to treat vocal fold scarring, including speech therapy, injection of various substances (such as corticosteroids, 2 HGF, 3 mitomycin‐C 4 ), stem cell therapy, 5 surgical therapy, 6 and so forth. However, these methods are mostly experimental and optimal treatment of vocal fold scar has yet to be established 7 …”

“…However, these methods are mostly experimental and optimal treatment of vocal fold scar has yet to be established. 7 Photodynamic therapy (PDT) is a widely approved therapy for a variety of skin lesions, 8 precancerous diseases, and malignancies. 9 It involves the activation of a photosensitizer by visible light to produce reactive oxygen species (ROS) which can induce cell death at high levels and influence cell signaling at low levels.…”