Trends in Utilization of Vocal Fold Injection Procedures

Abstract

Objectives: Office-based laryngeal procedures, vocal fold injections in particular, have become increasingly popular over the past 15 years. The purpose of this study was to examine trends in the use of different vocal fold injection techniques in the United States from 2000 to 2012 and see if they reflect this shift. Methods: The United States Part B Medicare claims database was queried from the years 2000 through 2012. The Current Procedural Terminology codes for indirect laryngoscopy with injection (31513), direct laryngoscopy with injection (31570), and direct laryngoscopy with injection, aided by telescope or operating microscope (31571) were used. For comparison, data for medialization laryngoplasty (31588) were also examined. The volume of procedures performed was tabulated for each code by year. Results: Over the time period studied, the number of non-operative laryngoscopic injections (31513, 31570) and operative medialization laryngoplasties remained constant. Operative vocal fold injection (31571) demonstrated significant, linear growth over the 12-year study period, from 744 procedures in 2000 to 4788 in 2012, an increase of over 640%. Conclusions: The dramatic increased incidence in the use of code 31571 reflects an increasing share of vocal fold injections being performed in the operating room and not in an office setting, which runs counter to the prevailing trend within laryngology of awake, office-based injection procedures. This may indicate that these procedures have become more popular over time within the otolaryngology community and are being performed increasingly by providers more comfortable with the controlled operating room setting.