Vocal fold medialization—A 5‐year series of single surgeon consecutive medialization with review of literature

Abstract

ENT UK released guidelines in 2010 detailing the requisite structure for the creation of a laryngeal intervention clinic. The senior author's practice is the only one regionally that offers this service, and our objective was to review this to determine whether vocal cord medialization injections were showing an improvement in quality of voice for patients. Patients were reviewed in a specialist voice clinic prior to being offered vocal cord injection under local anaesthetic in a separate dedicated weekly clinic. They would be assessed by the senior author and a dedicated voice specialist speech and language therapist (SALT). This would include a preinjection grade, roughness, breathiness, asthenia, and strain (GRBAS), Voice Handicap Index (VHI)-10, and the measuring of maximum phonation time (MPT) with the aid of Opera Vox Apple iPad application. Data were available for 186 injections, on patients with a median age of 66years (interquartile range [IQR]: 51-75), of whom 61% were male. VHI-10 score improved significantly, from a mean of 26.7 to 12.5 (P<.001). A significant improvement in MPT was also observed, from a median of 3.0 to 6.3 (N=66, P<.001). Improvements in all components of the GRBAS score were also observed (all P<.001), with between 43% and 88% of cases reporting reductions after the procedure. Patients receiving a repeat procedure saw a significantly smaller improvement in VHI-10 than those where it was the primary treatment (mean reduction: 9.8 vs 15.5, P=.018). Analysis of MPT found a significant correlation between the quantity of injection material used and the degree of improvement observed (rho=0.355, P=.004). Vocal Cord local anaesthetic medialization injection is a swift, safe, and effective short-term method of improving dysphonia.