S181 – Injection Laryngoplasty with Hyaluronic Acid

Abstract

Objectives To determine if particle size affects durability of medialisation in patients undergoing injection laryngoplasty (IL) with hyaluronic acid (HA) for unilateral vocal cord paralysis (UVCP). Hypothesis: Larger particle-size HA persists longer after injection to produce a more durable vocal result. Methods Study Design: Prospective randomized controlled single-blind trial. Years conducted: 2005–2007. Condition studied: UVCP. Subjects: Patients over the age of 18 requiring medialisation for UVCP. Setting: Outpatient clinic setting. Intervention: Patients underwent transcutaneous IL with Restylane (small particle-size HA) or Perlane (large particle-size HA). Outcome measurement: The Voice Handicap Index (VHI) at 6 months post-injection was the primary outcome measure. Secondary outcomes included videostroboscopic findings, and objective acoustic and aerodynamic measures. Statistical methods: Differences between groups were compared using the Mann Whitney U test and adjusted for age & gender using ANCOVA. Results 17 patients (8 Restylane, 9 Perlane) were available for follow-up at 6 months. Normalised VHI scores at 6 months after IL were significantly lower in the Perlane group compared to the Restylane group when not adjusted for age and sex (p=0.027). After adjustment the difference was not significant (p=0.053) but the Perlane group trended towards lower normalised VHI scores. Conclusions The findings support the hypothesis that the larger particle size of Perlane makes this material more durable than Restylane for IL. This material may be considered for temporary medialisation in patients with UVCP in whom medium-term improvement of at least 6 months is desirable. The trans-cutaneous route can be used safely in the office setting in non-anti-coagulated patients.