Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor

Abstract

Objectives Vocal fold scarring is caused by replacement of vocal fold mucosa with fibrous tissue due to repeated inflammation or trauma. It can lead to severe dysphonia. It is currently treated conservatively and with phonosurgery and intracordal injections. Intracordal injection of steroid or basic fibroblast growth factor (bFGF) has been recently found to be useful for treating vocal fold scarring that does not respond to voice therapy. Methods This retrospective study involved the administration of steroid injection and bFGF injection bilaterally under local anesthesia in 16 patients each. Laboratory measurements of voice parameters were performed before and 3–6 months after injection. Results In the steroid injection group, the Voice Handicap Index (VHI) score significantly improved from 57.1 to 40.5, total Grade, Roughness, Breathiness, Asthenia, Strain (tGRBAS) score significantly improved from 4.2 to 2.6, and mean speech fundamental frequency (SFF) increased from 192.5 to 211.4 dB, but there was no improvement in maximum phonation time (MPT) and mean airflow rate (MFR). In the bFGF injection group, significant improvements in the VHI score (from 53.3 to 35.7), MPT (from 16.9 to 21.8 s) and MFR (from 314.6 to 210.5 ml/s) were seen; however, the tGRBAS score did not improve. In addition, the SFF significantly decreased from 178.1 to 160.5 Hz. Conclusion These results suggest that both steroid and bFGF injections are effective for treating vocal fold scarring, with steroids improving voice quality and bFGF improving glottic closure, thereby contributing to improvements in VHI scores. Level of Evidence 4.

Age‐dependent treatment effect of vocal fold steroid injection for benign vocal fold lesions

“…Thus, steroid infusion therapy may not have a medialization effect for reducing the glottis gap. 20 These changes result in an enlarged glottal gap, and VFSI may not be sufficient to correct the age‐enhanced glottal gap.…”

“…In our previous study that investigated basic fibroblast growth factor and steroid injection for vocal fold scarring, the glottal gap decreased, bFGF improved MPT and MFR, and steroid did not improve MPT or MFR. Thus, steroid infusion therapy may not have a medialization effect for reducing the glottis gap 20 . These changes result in an enlarged glottal gap, and VFSI may not be sufficient to correct the age‐enhanced glottal gap.…”