Abstract
Background: Early injection laryngoplasty (EIL) using hyaluronic acid (HA) is an effective treatment for glottic insufficiency in patients with acute unilateral vocal fold paralysis (UVFP). Most patients benefit by showing improvement in voice and quality of life and implied reduced need for permanent laryngoplasty. However, injected HA might resolve within a short period, so its long-term outcomes and the need for secondary procedures need to be clarified. Methods: Patients who underwent EIL with HA for acute UVFP from January 2015 to December 2018 were included. The factors that may associate with the prognosis including voice performance and laryngeal configuration at presentation, the cause of UVFP, and the type of HA for EIL were analyzed. Results: Ninety-four patients were included for analysis, with a mean follow-up period of 25.1 months (95% CI: 22.8–27.4 months). After primary HA injection, 22 patients (23.4%) underwent secondary procedures (rate: 13.1% per person-year), and most (63.6%) of the events occurred after one year from the first injection. The rate of secondary procedures within the first 12 months was 9.0% (14.1% and 4.3% for low-concentrated HA (LHA) and high-concentrated HA (HHA), respectively). The incidence of the secondary procedures was higher in the LHA group (18.2%) (p = 0.026) than in the HHA group (7.5%). Conclusions: The rate of secondary procedures was lower than the prediction based on the resorption time of HA, a finding that could be partly accounted for by both natural nerve recovery and a long-lasting effect of EIL. EIL with HHA had a lower rate of re-treatment than that with LHA, suggesting a better clinical utility for acute UVFP.
Highlights
Injection laryngoplasty (EIL) with temporary materials is effective for unilateral vocal fold paralysis (UVFP)
hyaluronic acid (HA) has not been approved by the U.S Food and Drug Administration (FDA) for vocal injection, robust evidence shows its effectiveness and safety [4,9,11,12,15,19,20]; HA was recently accepted as an injectable material for vocal fold augmentation
The results of this study showed that approximately 93% of people with acute UVFP felt well and did not need secondary procedures within 12 months
Summary
Injection laryngoplasty (EIL) with temporary materials is effective for UVFP and may reduce the need for permanent laryngoplasty in specific patient groups [1,2,3]. Its therapeutic effect might last for only a limited period of time, so some patients still have to have secondary procedures, such as Biomolecules 2021, 11, 1580. Injection laryngoplasty (EIL) using hyaluronic acid (HA) is an effective treatment for glottic insufficiency in patients with acute unilateral vocal fold paralysis (UVFP). Injected HA might resolve within a short period, so its long-term outcomes and the need for secondary procedures need to be clarified. Methods: Patients who underwent EIL with HA for acute UVFP from January 2015 to December 2018 were included. The rate of secondary procedures within the first 12 months was 9.0%
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