Voice aerodynamics following office‐based hyaluronate injection laryngoplasty

Abstract

ObjectivesNeuromuscular control, glottal conformation and aerodynamics are the major factors affecting voice performance. We aimed to characterise the degree to which voice improvements following office‐based intracordal hyaluronate injection laryngoplasty (HIL) depend on changes in voice aerodynamics in patients with unilateral vocal fold paralysis (UVFP), by assessing the correlations between these parameters.DesignProspective case series.SettingOtolaryngology Clinics in a Medical Center.ParticipantsPatients with UVFP within 6 months of their first outpatient visit who received single HIL.Main outcome measuresVideolaryngostroboscopy, aerodynamics and laboratory voice analysis were evaluated at baseline and 1 month after HIL. Quantitative laryngeal electromyography was evaluated at baseline to confirm UVFP.ResultsSeventy‐five newly diagnosed patients with UVFP were analysed. The normalised glottal gap area (NGGA) decreased (P < 0.001) (Cohen's dz = 0.94) and all aerodynamic parameters improved (all P < 0.05) (Cohen's dz = 0.38‐1.02) following HIL. Patients undergoing thoracic surgery had more profound aerodynamic impairments both before and after HIL. After adjusting for improvements in NGGA, the improvement in aerodynamics was correlated with voice improvement and most notably with maximum phonation time and jitter/shimmer.ConclusionsHyaluronate injection laryngoplasty improved glottal conformation, aerodynamics and voice, highlighting the benefit of early HIL intervention for patients with UVFP. Patients with UVFP caused by thoracic surgery continued to have poorer aerodynamics post‐HIL, indicating the importance of speech therapy in these patients.

Reduction in Short‐ and Long‐term Pneumonia Rate With Laryngoplasty for Unilateral Vocal Fold Paralysis

“…Our research indicated that the 6‐month incidence rate of pneumonia in patients without treatment is high (207.5 per 1000 person‐years, aHR = 1.00) but is significantly lower in those with laryngoplasty (56.3 per 1000 person‐years, aHR = 0.34; 95% CI, 0.12‐0.95). Although the conventional strategy for UVFP treatment involves a wait‐and‐see approach, our research results indicate that treatment is the optimal strategy for patients 15 . Surgery can restore glottic function by minimizing the glottal gap 2 , 15 .…”

“…Although the conventional strategy for UVFP treatment involves a wait-and-see approach, our research results indicate that treatment is the optimal strategy for patients. 15 Surgery can restore glottic function by minimizing the glottal gap. 2,15 Glottal gap correction can reduce the incidence of aspiration and aspiration pneumonia.…”

“…The advancement of office-based injection laryngoplasty has afforded a more convenient treatment option that not only improves vocal and swallowing abilities but also prevents pneumonia. 15,21 Injection laryngoplasty has become the first-line treatment because it is noninvasive, its procedure is simple, biocompatible materials for the procedure have been developed, and it can be performed in an office. 22 Our result demonstrates the advantages of outpatient laryngoplasty: it is safe and convenient, and patients undergoing it had a lower incidence of pneumonia than those without it.…”

“…15 Surgery can restore glottic function by minimizing the glottal gap. 2,15 Glottal gap correction can reduce the incidence of aspiration and aspiration pneumonia. A minimal glottal gap can increase subglottic pressure and restore the power and productivity of coughing to discharge sputum with pathogens, thereby reducing the incidence of pneumonia.…”

“…Based on our experience, most outpatient laryngoplasty procedures are hyaluronic acid or autologous fat vocal fold injections, whereas inpatient surgical procedures are typically type I thyroplasty or arytenoid adduction procedures. 3,15 Because of database limitations, we could not distinguish surgical procedures for subgroup analysis. However, our study still indicated that outpatient laryngoplasty is a convenient, accessible, and effective treatment because patients undergoing it were less likely to develop pneumonia than untreated patients.…”