Office-based Injection Laryngoplasty Research Articles

Office-Based Injection Laryngoplasty in Patients with High Vagal Paralysis

Office-Based Injection Laryngoplasty in Patients with High Vagal Paralysis

Respiratory and voice outcomes of office-based injection laryngoplasty in patients with unilateral vocal fold paralysis

BackgroundInjection laryngoplasty is a surgical procedure used in management of glottal insufficiency. The objective of this study was to assess respiratory and voice outcomes of office-based injection laryngoplasty in patients with unilateral vocal fold paralysis (UVFP). Ten patients underwent office-based injection via transcutaneous approach using Radiesse or hyaluronic acid. Auditory perceptual assessment (APA), voice handicap index (VHI), size of the glottic gap, acoustic parameters (jitter, shimmer, and harmonic to noise ratio), maximum phonation time (MPT), stroboscopic evaluation, pulmonary function tests (PFTs), and videofluoroscopic evaluation of swallowing were done pre-injection, 1 week and 3 months post-injection.ResultsSubjective and objective voice outcomes, in addition to laryngostroboscopic parameters improved after injection. Non-significant difference was found between pre- and post-injection results of the PFTs.ConclusionsOffice-based injection laryngoplasty is a safe and effective method for treating UVFP. Patients with glottic gap (< 1–3 mm) are perfect candidates for such procedure. Injection laryngoplasty improves patients’ voice quality and does not impair respiration.

Evaluating Safety of Awake, Bilateral Injection Laryngoplasty for Bilateral Vocal Fold Atrophy

Office-based injection laryngoplasty (IL) has emerged as a useful procedure for otolaryngologists to correct glottic insufficiency while avoiding the costs and risks of general anesthesia. This is the first study focused on addressing the safety of bilateral IL for bilateral vocal fold (VF) atrophy. Patient records were reviewed from Emory University Hospital Midtown during the period of 2005 to 2017. Patients who underwent awake, bilateral transthyrohyoid, transoral, transcricothyroid, or transthyroid cartilage IL for bilateral VF atrophy were analyzed. All procedures, including repeat injections, were bilateral. Complication rate was used to evaluate safety. Patients with vocal cord paralysis, paresis, scar, and sulcus were excluded from the study. Total 174 procedures met inclusion criteria. There were four complications, yielding a complication rate of 2.3%. Complications included aborted cases for difficult anatomy or poor patient tolerance, injection material not resorbing, and a VF hematoma. No patients had any airway emergencies or required admission to the hospital or evaluation in the emergency room. This study illustrates a low complication rate for awake, bilateral IL in treating bilateral VF atrophy. This supports other studies that promote the safety of this procedure in the awake setting. Complications were associated with patient tolerance, unique anatomy, and in one case, anticoagulant medication. The low complication rate supports the conclusion that bilateral medialization IL is safe to perform in the office-based, awake setting.

Vocal Fold Paralysis Secondary to Subclavian Venous Thrombosis

The etiology of vocal fold paralysis is multifaceted. One of the rare causes is internal jugular vein thrombosis secondary to central venous catheterization. The palsy is usually ipsilateral to the site of indwelled catheterization, self-limited and reversible. The authors of this manuscript report a rare case of contralateral recurrent laryngeal nerve palsy induced by subclavian vein thrombosis following central venous catheterization. The patient developed irreversible vocal fold paralysis that necessitated office-based injection laryngoplasty.

Office-based Injection Laryngoplasty: Outcome after Hydroxylapatite Injection

Office-based Injection Laryngoplasty: Outcome after Hydroxylapatite Injection

Vocal Fold Insufficiency: How Effective is Injection Laryngoplasty? Short Term Clinical Outcomes.

Office based Injection Laryngoplasty has become a common and feasible method of addressing vocal fold insufficiency (VFI) resulting from a plethora of aetiologies. Contemporary to various injectates, Calcium Hydroxylapatite has met with great success across usage with various techniques. But, irrespective of the technique and injectate material, the burning question in mind of "realistic" clientele remains, "How soon will I have by voice back?". Aim of this study is to evaluate the short term (3months postoperative) effects of Injection Laryngoplasty in cases of VFI using Calcium Hydroxylapatite via trans cricothyroid route, in terms of both objective and subjective parameters. 12 patients with mean age of 35.67years underwent vocal fold injections (via transnasal flexible fibreoptic laryngoscopic guided trans-cricothyroid membrane approach using CaHA) for VFI. The pre injection and 1, 2- and 3-months post injection scores' changes in outcome measures in form of videostroboscopic parameters, Voice Handicap Index scores and acoustic analysis were compiled and analysed. 91.6% of patients showed statistically significant benefit after 3months post injection. 0.1% patients showed loss of benefit of the CaHA material even 3months post injection. Average length of benefit was 1-month post injection. No significant complication was observed in any patient. We conclude that the objective evidence of structural and functional improvement may be seen immediately post injection laryngoplasty, minimum of 3months is required for evident improvement in patient's perception of his own voice in terms of Quality of Life parameters.

Short term management of vocal fold paralysis

Vocal cord paralysis is commonly encountered by ENT surgeons. The standard management usually involves waiting for 6-12 months to assess for recovery or reinnervation. During this time, the patient usually experiences poor quality voice, ineffective cough, and aspiration which may result in pneumonia. Management of these patients includes a search for the aetiology and often requires speech therapy. In addition to this, a reversible, office-based early injection laryngoplasty can minimize the patient morbidity of impaired vocal fold mobility while maximizing glottal function and improving phonatory quality. Methods: A retrospective study was conducted on consecutive patients with unilateral vocal cord paralysis. Voice handicap index, basic and aerodynamic/acoustic data were collected at the initial assessment and following intervention. Intervention consisted of an office-based, unsedated, paraglottic injection of hyaluronic acid to the effected side. All patients underwent videostroboscopy before, during and after office intervention and subjective assessment of these recordings was made. Patients also completed the voice related quality of life. Results: All 185 patients tolerated office-based injection well with no adverse events. All patients experienced an improvement in glottal competency and this was reflected in the aerodynamic and acoustic data.

Arytenoid adduction and office based injection laryngoplasty

Arytenoid adduction and office based injection laryngoplasty

Vocal Cord Immobility After Thyroid Surgery: Treatment Option with Office-Based Injection Laryngoplasty

Abstract Introduction: Vocal cord immobility after thyroidectomy is not uncommon, with an incidence ranging from 0.5% to 3%. Patients may complain of dysphonia, which can include a weak or breathy ...

Contemporary Management of Unilateral Vocal Fold Paralysis

Program Description: This course will provide a comprehensive review of unilateral vocal fold paralysis (UVFP) management. The causes and workup of UVFP will be discussed. Special attention will be paid to office evaluation including utility of stroboscopy and laryngeal electromyography. Intervention including operating room–and office-based injection laryngoplasty will be described. The benefits of thyroplasty, arytenoid adduction, arytenopexy, and reinnervation will be debated. Case presentations will be used to highlight teaching points. Ample time will be allotted for audience participation and questions. Educational Objectives: (1) Describe how to perform a vocal fold injection. (2) Compare different methods to treat unilateral vocal fold paralysis.

Office-Based Injection Laryngoplasty for the Management of Unilateral Vocal Fold Paralysis

Office-based injection laryngoplasty (OBIL) is a common method of addressing glottal insufficiency. This retrospective chart review identifies the demongraphics, laterality, technique, success rate, injectates, and complications of OBIL performed over a 3-year period at a single institution. Retrospective chart review. All OBILs performed for the management of UVFP by the senior author over 3 years (2007-2009) were identified from billing records. The age, gender, laterality, underlying disease process, augmentation material, route of injection, and complications were recorded. Eighty-two OBILs were attempted on 57 patients. The most common route of access was transoral (85.6%). All OBILs were able to be completed. Injectates used were hyaluronic acid derivatives (57.3%), calcium hydroxyapatite (16%), and Cymmetra (16.5%). Three complications (3.7%) occurred. Thirty percent of patients ultimately elected for thyroplasty or ansa reinnervation, 22% found their condition to self-resolve, 14% died, and 25% were lost to follow-up. Using a variety of approaches, OBIL is possible in almost all patients. The single surgeon transoral route using a rigid angled telescope and curved injection needle was the most commonly used approach. Multiple injectates can be used and have good safety records. The final disposition of patients may be variable and warrants further investigation.

Higher risk of superficial injection during injection laryngoplasty in women

PurposeTo review our clinical experience with percutaneous injection laryngoplasty at a single institution over a three-year period, and to specifically assess the rate of unintentional injection into the superficial lamina propria (SLP) and compare with results found in the literature. Materials and methodsMedical records were retrospectively reviewed to identify patients who underwent office-based injection laryngoplasty (OBIL) over a three-year period. Video documentation and the written notes of the procedures were reviewed to determine the rate of inadvertent placement of injectate into the SLP. A literature review was performed to identify other reports of this complication and contributing factors. Results113 consecutive patients were identified who underwent OBIL in the study period. Of these, 100 patients had adequate records and follow-up available for this review. All patients underwent injection augmentation with bovine collagen using a percutaneous trans-membrane or trans-cartilaginous technique. 96 had improvement in their vocal quality and/or effort. Four patients, who were all women, had unintentional injection into the SLP with resultant no change in voice or worsened voice. All superficially placed injectates were managed conservatively. ConclusionsInjection into the SLP is a well-recognized possible complication of OBIL. Our results suggest that this complication occurs more often in women than in men, perhaps due to differing laryngeal anatomy and size.

Prospective Evaluation of Office-Based Injection Laryngoplasty with Hyaluronic Acid Gel

The role of Juvederm Ultra Plus hyaluronic acid gel for use in injection laryngoplasty has not been well examined. The aim of this study was to prospectively assess the safety and clinical effectiveness of office-based injection laryngoplasty of Juvederm Ultra Plus gel in patients with glottic insufficiency. Thirty patients met the criteria for study inclusion and were treated with unsedated office-based injection laryngoplasty of Juvederm Ultra Plus gel over a 20-month period. The preinjection acoustic and aerodynamic measures, Voice Handicap Index, Glottal Function Index, and Dysphonia Severity Index were compared with values recorded at 1 and 4 months after injection. Data for 27 patients were available for follow-up analysis at 1 month, and 12 patients' data were available at 4 months. Significant improvements, compared to preinjection levels (p < 0.02), were shown in all outcome measures at 1 and 4 months. One patient required intravenous steroid therapy for delayed glottic inflammation that resolved without permanent sequelae. The injection of Juvederm Ultra Plus gel is a relatively safe procedure that allows for short-term improvements in objective and subjective outcome measures of vocal function in patients with glottic insufficiency, provided the surgeon remains alert to the possibility of postprocedural injection site inflammation.

Office‐Based Injection Laryngoplasty with Hyaluronic Acid Gel

Objective: Many injectables are available for vocal fold augmentation, but the role of Juvederm Ultra Plus hyaluronic acid gel has not been well examined. This study was conducted to assess the safety and clinical effectiveness of office-based injection laryngoplasty of Juvederm Ultra Plus gel in patients with glottic insufficiency (GI). Method: Prospective case series of 27 patients with GI treated with unsedated office-based injection laryngoplasty of Juvederm Ultra Plus gel over a 20 month period. Preinjection acoustic and aerodynamic measures, Voice Handicap Index, Glottal Function Index, and Dysphonia Severity Index were compared with values recorded at 1 and 4 months postinjection. Results: Data for 26 patients were available for follow-up analysis at 1 month, and 12 patients’ data were available at 4 months. Etiologies of GI included presbylaryngis (n = 11), unilateral vocal fold paralysis (n = 10), scar (n = 2), and others (n = 5). Eighty-nine percent underwent transoral injection, and 11% received transcervical injections. Significant improvements compared to preinjection levels ( P &lt; .03) were shown in all outcome measures at 1 and 4 months, respectively. Although there were no procedural complications, 1 patient required intravenous steroid therapy for temporary glottic inflammation that resolved without permanent sequelae. Conclusion: The injection of Juvederm Ultra Plus gel is a safe procedure that allows for reliable improvements in objective and subjective outcome measures of vocal function in patients with GI provided the surgeon remains alert for the possibility of postprocedural injection site inflammation.

Neck Surface Electromyography as a Measure of Vocal Hyperfunction before and after Injection Laryngoplasty

The goal of this preliminary study was to determine whether neck surface electromyography (sEMG) is sensitive to possible changes in vocal hyperfunction associated with injection laryngoplasty, particularly with respect to alterations in the degree of vocal hyperfunction. Thirteen individuals undergoing office-based injection laryngoplasty for glottal phonatory insufficiency were prospectively studied with a battery of acoustic, aerodynamic, endoscopic, and anterior neck sEMG assessments before the procedure and approximately 1 week afterward. Anterior neck sEMG values were not significantly reduced (p < 0.05) after the procedure; however, perceptual ratings of strain and false vocal fold compression were both significantly reduced, reflecting a decrease in vocal hyperfunction. The results do not support the use of anterior neck sEMG measures to assess vocal hyperfunction, and place into question the use of some other measures (estimates of anterior-posterior supraglottic compression, quantitative measures of anterior-posterior and false vocal fold supraglottic compression, and acoustic vowel rise times) that have been considered reflective of vocal hyperfunction.

Voice Outcomes After Endoscopic Injection Laryngoplasty with Hyaluronic luronic Acid Stabilized Gel

A variety of materials as well as approaches have been used to treat glottic insufficiency, but the ideal procedure has yet to be determined. The goal of this study was evaluate the safety and efficacy of cross-linked hyaluronic acid (Restylane) for office-based injection laryngoplasty for the treatment of vocal fold (VF) immobility. Retrospective chart review. Twenty-seven patients were with diagnosed VF immobility. Twenty-five received Restylane VF injections in the office setting via percutaneous, trans-thyrohyoid injection with distal chip endoscopic guidance. Two patients received injections using suspension microlaryngoscopy under general anesthesia. Voice outcomes were followed using the Voice-Related Quality of Life Survey and the Voice Outcome Survey. Four patients were lost to follow-up immediately after injection. 20 of 23 patients (87%) reported subjective improvement in voice. Analysis of subjective surveys from nine patients revealed a trend toward improvement of V-RQOL from 34 to 23 (P = 0.083) but did not reach significance. After compilation of all VOS questions, 69% of all follow-up responses noted improvement of symptoms, 24% were unchanged and 7% were worse. Office-based injection laryngoplasty with Restylane appears to be a safe procedure that improves vocal function in patients with glottal insufficiency due to impaired VF mobility. Further studies are required to quantify the benefits and to compare the effects with other injectable materials.

Operating Room Versus Office‐Based Injection Laryngoplasty: A Comparative Analysis of Reimbursement

Injection laryngoplasty (IL) continues to evolve as new indications, techniques, approaches, and injection materials are developed. Although historically performed under local or general anesthesia in the operating room suite, IL is now increasingly being performed in an office-based setting. This report presents the results of a reimbursement analysis comparing office-based versus operative IL. The objective of this study was to compare the reimbursement of office-based injection laryngoplasty with the reimbursement of performing the same procedure in the operating room. The authors conducted reimbursement and outcome analysis through retrospective office chart and hospital record review. A retrospective review was performed of the hospital records of patients having undergone injection laryngoplasty at the University of Pittsburgh Voice Center from July 1998 through March 2005. Group I included patients who underwent IL in the operating room, whereas group II included those who had office-based IL. A reimbursement analysis for both groups was then performed comparing surgeon fees, anesthesia, and hospital charges and reimbursement. The clinical efficacy of IL performed in either office versus operating room settings was measured by comparing the pre- and postintervention Voice Handicap Index-10 scores for all patients. A predictive model of potential cost savings is developed based on the results of the analysis. Average reimbursement was 2,505 dollars for group I (n = 108) and 496 dollars for group II (n = 50). This reimbursement differential was preserved across the various insurance types examined. There was no significant difference in Voice Handicap Index-10 change after surgery between group I and II. Office-based IL is both clinically and financially effective, providing patients with a convenient and flexible alternative to operating room-based intervention for glottal insufficiency.