Results of Magnetic Resonance Imaging Assessment, Acoustic Analysis, Phonatory Function and Perceptual Rating of Glottic Insufficiency before and after Fat Augmentation: Correlated with Subjective Rating

Abstract

Autogenous fat augmentation has been proven effective in the treatment of glottic insufficiency (GI) using both subjective and objective methods of evaluation. However, no information is available in published research regarding the effectiveness and predictability of value parameters with regard to patients’ perceptions and concerns. This article retrospectively examines the correlation between subjective and objective examinations and subjective ratings (SRs) in patients with presbylaryngis (n = 14) and sulcus vocalis (n = 2). Acoustic analysis, phonatory function, magnetic resonance imaging (MRI) assessment, and perceptual rating data were evaluated against SRs using pre- and postoperative test results in 16 patients. The mean time over which subjective and objective examinations were performed was 10 months. Twelve patients reported excellent results, while no change was observed in 4 patients. When compared against SR, the kappa value of jitter, shimmer, harmonic to noise ratio, phonation time, grade, roughness, breathiness, and MRI were 0.25, 0, –0.08, –0.11, –0.11, 0.18, 0, and 1, respectively. The agreement between the MRI and SR values was complete, and was the only relationship shown to be significant (p < 0.001). MRI assessment is an effective and reliable examination tool which can be considered for use in assessing the progress of the post-fat injection operation in GI patients during follow-up examinations. Furthermore, due to the excellent agreement between MRI assessment and the patients’ subjective feelings, the SR value may serve as a good index of fat survival.

Bilateral vocal fold injection with autologous fat in patients with vocal fold atrophy with or without sulcus

“…Autologous fat injection is known to be safe [ 21 ], but the long-term (> 1 year) benefits are less consistent [ 12 , 19 , 22 , 23 ]. The effectiveness of autologous fat injection in patients with non-paralytic glottic insufficiency caused by atrophy with or without sulcus has been studied to a lesser extent, with generally positive subjective results [ 19 , 22 – 24 ]. Chen et al reported excellent results in 62.5% of their patients based on subjective patient ratings, together with an overall significant improvement in the perceptual rating of grade, roughness, and breathiness, and videolaryngostroboscopic rating [ 22 ].…”

Implantation of gelatin sponge combined with injection of autologous fat for sulcus vocalis

“…Injectable materials include synthetic substances such as calcium hydroxylapatite (CaHA) and Gelfoam, as well as autologous fat and collagen 3 , 11 . Gelfoam, autologous fat, and collagen all show reabsorption once injected; thus reinjection is often necessary 3 , 6 , 7 – 10 , 12 . As with medialization thyroplasty, foreign body reactions can also be a concern.…”

“…3,11 Gelfoam, autologous fat, and collagen all show reabsorption once injected; thus reinjection is often necessary. 3,6,[7][8][9][10]12 As with medialization thyroplasty, foreign body reactions can also be a concern. In both augmentation injection and medialization thyroplasty, material is generally added to the paraglottic space or musculature, not the superficial lamina propria of the vocal fold; thus adhesion in the vocal fold is not corrected.…”

Glottis injection to improve voice function

“…Abb. 4).Autologes Fettgewebe hat gute elastische Eigenschaften und ist sehr gut verträg-lich[18]. Es wird vom Patienten vor der Injektion durch Liposuktion oder Exzision aus der Bauchwand gewonnen.…”