orabase and Dysphonia

Clinical indications for vocal fold injection augmentation (VFI) are expanding. Prior studies demonstrate the benefit of trial VFI for select causes of glottic insufficiency. No studies have examined trial VFI for glottic insufficiency resulting from true vocal fold (TVF) scar.. Retrospective chart review of patients who underwent trial VFI for a dominant pathology of TVF scar causing dysphonia. Patients who subsequently underwent durable augmentation were identified. The primary study outcome was the difference in Voice Handicap Index-10 (VHI-10) score from pretrial VFI to post-durable augmentation.. Twenty-eight patients underwent trial VFI for TVF scar, 22 of whom reported a positive response. Fifteen of 22 subjects who underwent durable augmentation had viable data for analysis. Mean VHI-10 improved from 26.9 to 18.6 ( P < .05), for a delta VHI-10 of 8.3, or 30.9% improvement. Twelve of the 15 (80%) showed a clinically significant improvement (delta VHI-10 >5).. A trial VFI is a potentially useful, low-risk procedure that appears to help the patient and clinician identify when global augmentation might improve the voice when vocal fold scar is present. Patients who reported successful trial VFI often demonstrated significant improvement in their VHI-10 after subsequent durable augmentation.

Topics: Adult; Aged; Aged, 80 and over; Carboxymethylcellulose Sodium; Cicatrix; Dysphonia; Female; Follow-Up Studies; Humans; Injections; Laryngeal Diseases; Male; Middle Aged; Patient Satisfaction; Retrospective Studies; Vocal Cords; Voice Quality

Dysphonia significantly damages quality of life and employment opportunities. One of the common causes of hoarseness is glottic insufficiency, namely the lack of full adherence of the vocal cords during speech and swallowing. Correction is achieved by vocal cord medialization.. To examine the effect of vocal cord injection with carboxymethyl cellulose and hydroxyapatite under local anesthesia in the office, on the voice objectively, assessment by staff and patient satisfaction.. This prospective and retrospective study included 38 vocal cord injections: 30 involved carboxymethyl cellulose injections, and 8 were injected with hydroxyapatite. Objective and subjective parameters were collected before the injection and 1-2 weeks after the injection.. Average subjective disturbance of the voice decreased from 5.9 to 4.1 post-injection (p<0.01). Average Voice Handicap Index (VHI) decreased from 75.3 to 39.1 (p<0.01) and average Glottic Function Index (GFI) decreased from 15.7 to 9.5 (p<0.01). Average GRABS decreased from 11.9 to 6 (p<0.01) and average visual analogue scale decreased from 4 to 2.5 (p<0.01). Average Maximal Phonation Time increased from 6.9 to 9 sec (p=0.1). Average S/Z ratio decreased from 1.8 to 1.3 (p=0.1). Voice analysis showed average jitter decreased from 2.4% to 0.8% (p<0.01) and average shimmer from 10.9% to 5% (p<0.01).. Vocal cord injection under local anesthesia in the office is a good and safe method for treating glottic insufficiency. Vocal cord injection with carboxymethyl cellulose and hydroxyapatite improves objective and subjective voice properties.

Topics: Carboxymethylcellulose Sodium; Durapatite; Dysphonia; Humans; Phonation; Prospective Studies; Quality of Life; Retrospective Studies; Treatment Outcome; Vocal Cords; Voice Quality