Safety of Platelet‐Rich Plasma Subepithelial Infusion for Vocal Fold Scar, Sulcus, and Atrophy

Abstract

Objective To demonstrate the safety profile of platelet‐rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy. Methods Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post‐injection at each session. Patient‐reported outcomes were collected at every visit using the Voice Handicap Index‐10 (VHI‐10) and Vocal Fatigue Index (VFI) questionnaires. Results Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty‐three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6–2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri‐procedural complications. The average duration of follow‐up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient‐reported outcomes at the 3 month follow up (n = 9) follow‐up (mean ΔVHI‐10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two‐tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results. Conclusion This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri‐procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study. Level of Evidence 4 Laryngoscope, 133:647–653, 2023

Platelet‐rich plasma in treatment of scar, atrophy, and sulcus: Short‐ and long‐term results

“…Animal studies support the use of PRP for vocal‐fold healing 36 . Previous studies have also noted short‐term improvements with PRP use 22,24 …”

“…36 Previous studies have also noted shortterm improvements with PRP use. 22,24 Over the last 18 years, ample literature has been published on the use of growth factors and stem cells in laryngology. 13,[37][38][39] In a report on b-FGF in 100 cases, Hirano also noted better improvements in mild-to-moderate dysphonia than in severe cases.…”

“…Woo and Murry showed short‐term improvements in voice quality 23 . In a safety and efficacy study, Johns et al showed that PRP is safe, with minor reported morbidity 24 . Since then, other authors have used PRP during phonosurgery, 25 acute vocal injury, 26 and in combination with fat grafting 27 .…”

“… 23 In a safety and efficacy study, Johns et al showed that PRP is safe, with minor reported morbidity. 24 Since then, other authors have used PRP during phonosurgery, 25 acute vocal injury, 26 and in combination with fat grafting. 27 However, long‐term PRP results are unavailable.…”

Current and Future Developments in Wound Healing

“…63 The benefit of using autologous PRP to improve wound healing in acute wounds is more controversial but favors reduced risk of infections. 64 Additionally, promising future applications in otolaryngology for autologous PRP include enhanced wound healing following total laryngectomy, 65 improved vocal quality in treatment of vocal fold scar and atrophy, 66,67 and improved healing of chronic tympanic membrane perforations following tympanoplasty. 68,69 Hair Follicle Transplantation Brown and McDowell were the first to observe that wounds in areas without hair follicles, such as the palms and soles, heal slower than wounds in hair-bearing areas and proposed that hair follicles play a role in wound healing.…”