Injection laryngoplasty outcomes in irradiated and nonirradiated unilateral vocal fold paralysis.

OBJECTIVES/HYPOTHESIS: To evaluate the effect of radiation therapy on voice outcome and duration of effect of calcium hydroxylapatite (CaHA) injection laryngoplasty in unilateral vocal fold paralysis (UVFP) patients. STUDY DESIGN: Retrospective case series. METHODS: UVFP patients treated with CaHA injection laryngoplasty at the University of California San Francisco Voice and Swallowing Center were identified. Demographic information, history of irradiation to the larynx, and time to additional medialization procedures were obtained. Examinations at presentation and follow-up were analyzed for laryngostroboscopic parameters and CAPE-V scores. RESULTS: Four nonirradiated and five irradiated patients underwent a total of six and nine injection laryngoplasties, respectively. Time to additional procedures was longer in irradiated patients (P = 0.02). Prior to injection, nonirradiated patients had more severe glottic insufficiency (P = 0.007, 0.002) than did irradiated patients. Postinjection, irradiated patients demonstrated improvement in overall voice quality, breathiness, and loudness, while nonirradiated patients demonstrated improved overall quality, breathiness, pitch, and loudness. Voice quality was not statistically different between patient groups. CONCLUSION: CaHA injection laryngoplasty improved voice quality in both irradiated and nonirradiated patients. Nonirradiated patients experience greater vocal improvement compared to irradiated patients. Vocal cord stiffness due to radiation-induced changes may be responsible for the lack of improvement in pitch. Time to additional procedures was longer in irradiated patients and may be secondary to effects of prior radiation on graft resorption. Vocal fold medialization with CaHA injection remains a safe and efficacious treatment for UVFP in both irradiated and nonirradiated patients.

Long-term effects of injection laryngoplasty with a temporary agent on voice quality and vocal fold position.

OBJECTIVES/HYPOTHESIS: Patients with unilateral vocal fold paralysis (UVFP) treated with temporary injection laryngoplasty (IL) have a decreased rate of permanent medialization laryngoplasty (ML) compared to UVFP patients initially treated by observation. The aim of this study was to determine whether the lower rate of ML corresponded with improved quantifiable measures. STUDY DESIGN: Retrospective review. METHODS: Examinations at presentation and follow-up of 14 IL patients and 24 observation patients were analyzed for laryngoscopic features and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores. RESULTS: The groups were similar at presentation. At follow-up, the IL group showed significant improvement in 11/18 laryngoscopic criteria and 7/12 CAPE-V parameters compared to the observation group (P < .05). The observation group underwent ML more frequently than the IL group (75% vs. 29%, P = .008). CONCLUSIONS: The lower rate of permanent ML in patients undergoing temporary IL corresponds with improvements in CAPE-V scores and laryngoscopic features. Improvements persisted beyond the accepted time frame for temporary graft resorption.