Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis

Vinson, Kimberly; Zraick, Richard I.; Ragland, Felicia J

doi:10.1002/lary.20982

Cited by 44 publications

(6 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since MT and IL utilize the same medialization treatment paradigm, these techniques are often applied in similar clinical scenarios. Outcomes between treatment options have been compared and have been found to yield similar clinical outcomes [ 3 – 6 ]. MT offers a permanent solution but requires operating room time and sedation.…”

Section: Introductionmentioning

confidence: 99%

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis

Tam

Sun

Sarma

et al. 2017

J of Otolaryngol - Head & Neck Surg

View full text Add to dashboard Cite

BackgroundMedialization thyroplasty and injection laryngoplasty are widely accepted treatment options for unilateral vocal fold paralysis. Although both procedures result in similar clinical outcomes, little is known about the corresponding medical care costs. Medialization thyroplasty requires expensive operating room resources while injection laryngoplasty utilizes outpatient resources but may require repeated procedures. The purpose of this study, therefore, is to quantify the cost differences in adult patients with unilateral vocal fold paralysis undergoing medialization thyroplasty versus injection laryngoplasty.Study designCost minimization analysis conducted using a decision tree model.MethodsA decision tree model was constructed to capture clinical scenarios for medialization thyroplasty and injection laryngoplasty. Probabilities for various events were obtained from a retrospective cohort from the London Health Sciences Centre, Canada. Costs were derived from the published literature and the London Health Science Centre. All costs were reported in 2014 Canadian dollars. Time horizon was 5 years. The study was conducted from an academic hospital perspective in Canada. Various sensitivity analyses were conducted to assess differences in procedure-specific costs and probabilities of key events.ResultsSixty-three patients underwent medialization thyroplasty and 41 underwent injection laryngoplasty. Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19. Results showed that cost savings with IL were C$1555.91. Deterministic and probabilistic sensitivity analyses suggested cost savings ranged from C$596 to C$3626.ConclusionsTreatment with injection laryngoplasty results in cost savings of C$1555.91 per patient. Our extensive sensitivity analyses suggest that switching from medialization thyroplasty to injection laryngoplasty will lead to a minimum cost savings of C$596 per patient. Considering the significant cost savings and similar effectiveness, injection laryngoplasty should be strongly considered as a preferred treatment option for patients diagnosed with unilateral vocal fold paralysis.

show abstract

Section: Introductionmentioning

confidence: 99%

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis

Tam

Sun

Sarma

et al. 2017

J of Otolaryngol - Head & Neck Surg

View full text Add to dashboard Cite

show abstract

“…Surgery of UVFP consists basically in two techniques: open surgery on the laryngeal box and injection laryngoplasty with autologous or nonautologous materials [ 2 ]. Open procedures require a major surgical operation, and conditions after a follow-up at six months [ 22 ] may be similar to the initial situation.…”

Section: Discussionmentioning

confidence: 99%

Injection Laryngoplasty Using Autologous Fat Enriched with Adipose-Derived Regenerative Stem Cells: A Safe Therapeutic Option for the Functional Reconstruction of the Glottal Gap after Unilateral Vocal Fold Paralysis

Lasso

Poletti

Scola

et al. 2018

Stem Cells International

View full text Add to dashboard Cite

Background Paralysis of one vocal fold leads to glottal gap and vocal fold insufficiency that has significant impact upon a patient's quality of life. Fillers have been tested to perform intracordal injections, but they do not provide perdurable results. Early data suggest that enriching fat grafts with adipose-derived regenerative cells (ADRCs) promote angiogenesis and modulate the immune response, improving graft survival. The aim of this study is to propose ADRC-enriched adipose tissue grafts as effective filler for the paralyzed vocal fold to use it for functional reconstruction of the glottal gap. Method This is the first phase I-IIA clinical trial (phase I/IIA clinical trial, unicentric, randomized, controlled, and two parallel groups), to evaluate the safety of a new therapy with ADRC-enriched fat grafting (ADRC: group I) for laryngoplasty after unilateral vocal fold paralysis. Control group patients received centrifuged autologous fat (CAF: group II) grafts. Overall mean age is 52.49 ± 16.60 years. Group I (ADRC): 7 patients (3 males and 4 females), 52.28 ± 20.95 year. Group II (CAF): 7 patients (3 males and 4 females), 52.71 ± 12.59 year. Results VHI-10 test showed that preoperative mean score was 24.21 ± 8.28. Postoperative mean score was 6.71 ± 6.75. Preoperative result in group I was 21.14 ± 3.58 and postoperative result was 3.14 ± 3.53. Preoperative result for group II was 27.29 ± 10.66. Postoperative score in group II was 10.29 ± 7.52. Wilcoxon and the Student t-tests showed that the patient's self-perception of posttreatment improvement is larger when ADRCs are used. Comparing pre- and posttreatment voice quality analysis, group I showed a p = 0.053. Group II showed a p = 0.007. There would be no significant differentiation between pre- and posttreatment results. This is true for group II and limited for group I. Conclusions This prospective trial demonstrates the safety and efficacy of the treatment of glottal gap defects utilizing ADRC-enriched fat grafts. This trial is registered with NCT02904824.

show abstract

“…The goal of treatment for UVFP in these cases is to improve glottic closure, thus improving the voice and avoiding aspiration during swallowing for the remainder of their lives. Medialization thyroplasty has been considered as the definitive treatment of choice for UVFP [7,8], but there are concerns regarding its suitability in patients with neck irradiation and its invasiveness in terminally ill patients, in whom tolerance, safety, compliance, and comfort are major considerations. Palliative therapy for UVFP in terminally ill patients should focus on improving their quality of life by restoring their voice and swallowing function.…”

Section: Discussionmentioning

confidence: 99%

In-Office Hyaluronate Injection Laryngoplasty as Palliative Treatment for Unilateral Vocal Fold Paralysis

Soriano

Pei²,

Fang³

2016

ORL

View full text Add to dashboard Cite

Background: Voice and swallowing impairments can impact on both quality of life and survival. Unilateral vocal fold paralysis (UVFP) as a result of distant metastasis can cause breathy voice and aspiration. The purpose of this study is to develop and evaluate a less invasive and effective alternative therapy for UVFP. Methods: This was a retrospective review of prospectively enrolled patients at a tertiary referral center in Taiwan. Among a cohort of 177 patients who received intracordal hyaluronate injections, 2 had UVFP from distant metastasis and met the inclusion criteria. Vocal cord motion was recorded by videostroboscopy, and the normalized glottal gap area was measured. Voice quality, defined by speech language pathologists, and swallowing status were compared, and immediate complications after the injection were investigated. Results: Two patients with UVFP with M1 lesions (both lung) accepted the procedure. The glottal gap area was significantly improved 1 month after in-office hyaluronate injection. Voice quality and aspiration were also improved. No immediate complications were noted in either patient. Conclusions: In-office intracordal hyaluronate injection is a safe and effective treatment for UVFP, providing a palliative method to help maintain the patient's voice and quality of life.

show abstract

Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis

Abstract: Injection and medialization laryngoplasty were comparable in achieving voice improvement at the average long-term follow-up of 6 months.

Cited by 44 publications

References 23 publications

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis

Injection Laryngoplasty Using Autologous Fat Enriched with Adipose-Derived Regenerative Stem Cells: A Safe Therapeutic Option for the Functional Reconstruction of the Glottal Gap after Unilateral Vocal Fold Paralysis

In-Office Hyaluronate Injection Laryngoplasty as Palliative Treatment for Unilateral Vocal Fold Paralysis

Contact Info

Product

Resources

About