Abstract
PurposeTo 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.MethodsVoice 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.ResultsThe 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.ConclusionThe 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.
Highlights
Vocal fold atrophy is defined as loss of muscle bulk and tone of the thyro-aytenoid/lateral cricoarytenoid complex in a vocal fold with a normal range of motion [1]
To our knowledge this is the largest study on trial vocal fold injection (VFI) to date
We found that the majority of patients reported a good response to the trial VFI, which was defined as enough subjective benefit to want to undergo a durable medialization procedure
Summary
Vocal fold atrophy is defined as loss of muscle bulk and tone of the thyro-aytenoid/lateral cricoarytenoid complex in a vocal fold with a normal range of motion [1]. It is a common cause of dysphonia in non-paralytic glottic insufficiency. Atrophy can be found in younger patients who report similar complaints from childhood or early adolescence and have a comparable clinical presentation, suggesting a young adolescent form of vocal fold atrophy This phenomenon has been observed by others [5]. For presbyphonia improvement in vocal function after speech therapy has been observed, but is influenced by degree of atrophy, glottis closure pattern and patient’s burden of medical problems [7]
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