Early infiltration in vocal cord paralysis: evolution and predictors
Abstract Introduction and objective: Vocal cord paralysis is a prevalent and disabling pathology. The main objective is to compare the recovery of movility and functionality of vocal cords, as well as the requirement of definitive surgery in two groups of patients: non-infiltrated group (NIG) versus early infiltration group with hyaluronic acid (EIG). Method: Retrospective observational study. To set up the NIG, we sorted the database of 715 videos labeled as “laryngeal paralysis” and selected n=33 patients who met the inclusion criteria of the study. To create the EIG, we selected patients injected with hyaluronic acid in the last 3 years (n=22). In the NIG, the following were analyzed as outcome measures: recovery of mobility and functionality of the cord and the need for thyroplasty. In the EIG, the date of infiltration was also measured. Results: The results of the EIG are significantly better (p=0,001) in terms of vocal cord mobility recovery. A non-significant reduction (p=0.14) was observed in the need for thyroplasty in injected patients. There are significant differences between patients with unilateral paralysis of the NIG vs EIG (p=0.009), while the bilateral groups are not comparable, due to the compromise of the airway suffered by patients with the cord in a medial position. Discussion: Early infiltration with hyaluronic acid provides temporary treatment of the glottic closure defect with a low rate of complications, prolonging the maximum phonation time and improving the vocal movement, which may reduce the need for subsequent treatments. It has been proposed as a treatment that can improve the patient’s quality of life. However, it is important to properly select patients, since not all may be candidates. Conclusions: Early infiltration with hyaluronic acid generates a significant improvement in the recovery of vocal cords mobility, supporting the early indication of this therapy. Although a lower need for thyroplasty is observed in GIT, the differences are not significant.
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Milan R A, Michael M. J. Decision Making in Vocal Fold Paralysis New York: Springer; 2019.
Yumoto E. Pathophysiology and Surgical Treatment of Unilateral Vocal Fold Paralysis. In. Japan: Springer; 2015. p.6.
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Miaskiewicz B, Panasiewicz A, Nikiel K, Wlodarczyk E, Gos E, Szkielkowska A. Comparison of 24-month voice outcomes after injection laryngoplasty with calcium hydroxylapatite or hyaluronic acid in patients with unilateral vocal fold paralysis. Am J Otolaryngol. 2022;43(1):103207. doi: 10.1016/j.amjoto.2021.103207.
Zeleník K, Formánek M, Walderová R, Formánková D, Komínek P. Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite. Eur Arch Otorhinolaryngol. 2021;278(4):1139-1144. doi: 10.1007/s00405-020-06479-6.
Lahav Y, Malka-Yosef L, Shapira-Galitz Y, Cohen O, Halperin D, Shoffel-Havakuk H. Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes. Otolaryngol Head Neck Surg. 2021;164(3):631-638. doi: 10.1177/0194599820947000.
Gotxi-Erezuma I, Ortega-Galván M, Laso-Elguezabal A. Laringoplastia de inyección con ácido hialurónico guiada por EMG en etapa precoz de parálisis unilateral de cuerda vocal. Acta Otorrinolaringológica Española. 2017; 68(5):274-283
Kang MG, Seo HG, Chung EJ, Lee HH, Yun SJ, Keam B et al. Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer-related unilateral vocal cord paralysis. Laryngoscope Investig Otolaryngol. 2021;6(4):800-806. doi: 10.1002/lio2.618.
Ryu CH, Kwon TK, Kim H, Kim HS, Park IS, Woo JH et al. Guidelines for the Management of Unilateral Vocal Fold Paralysis From the Korean Society of Laryngology, Phoniatrics and Logopedics. Clin Exp Otorhinolaryngol. 2020;13(4):340-360. doi: 10.21053/ceo.2020.00409.
Wang CC, Wu SH, Tu YK, Lin WJ, Liu SA. Hyaluronic Acid Injection Laryngoplasty for Unilateral Vocal Fold Paralysis-A Systematic Review and Meta-Analysis. Cells. 2020 5;9(11):2417. doi: 10.3390/cells9112417.
Liao LJ, Wang CT. Management of Unilateral Vocal Fold Paralysis after Thyroid Surgery with Injection Laryngoplasty: State of Art Review. Front Surg. 2022 6;9:876228. doi: 10.3389/fsurg.2022.876228.
Lee YC, Pei YC, Lu YA, Chung HF, Li HY, Lee LA et al. Long-Lasting Effect after Single Hyaluronate Injection for Unilateral Vocal Fold Paralysis: Does Concentration Matter? Biomolecules. 2021 26;11(11):1580. doi: 10.3390/biom11111580.
Pan S, Sadoughi B. Effectiveness of Injection Laryngoplasty for Aspiration in Acute Iatrogenic Vocal Fold Paralysis: A Systematic Review. Laryngoscope. 2022;132(4):813-821. doi: 10.1002/lary.29326.
Reder L, Bertelsen C, Angajala V, O'Dell K, Fisher L. Hospitalized Patients With New-Onset Vocal Fold Immobility Warrant Inpatient Injection Laryngoplasty. Laryngoscope. 2021;131(1):115-120. doi: 10.1002/lary.28606.
Mau T, Courey MS. Influence of gender and injection site on vocal fold augmentation. Otolaryngol Head Neck Surg. 2008;138(2):221-5. doi: 10.1016/j.otohns.2007.10.028.
Rapoport , Murry , Woo. Voice assessment of fat injection vs medialization laryngoplasty in nonparalytic dysphonia. Laryngoscope Investig. Otolaryngol. 2021; 53-457.
Marques JAS, Marronnier A, Crampon F, Lagier A, Marie JP. Early Management of Acute Unilateral Vocal Fold Paralysis: Update of the Literature. J Voice. 2021;35(6):924-926. doi: 10.1016/j.jvoice.2020.02.021.
Rapoport SK, Murry T, Woo P. Voice assessment of fat injection vs medialization laryngoplasty in nonparalytic dysphonia. Laryngoscope Investig Otolaryngol. 2021;27;6(3):453-457. doi: 10.1002/lio2.573.
Verma SP, Dailey SH. Office-based injection laryngoplasty for the management of unilateral vocal fold paralysis. J Voice. 2014;28(3):382-6. doi: 10.1016/j.jvoice.2013.10.006.
Filauro M, Vallin A, Fragale M, Sampieri C, Guastini L, Mora F et al. Office-based procedures in laryngology. Acta Otorhinolaryngol Ital. 2021;41(3):243-247. doi: 10.14639/0392-100X-N0935.
Yumoto E. Pathophysiology and Surgical Treatment of Unilateral Vocal Fold Paralysis. In. Japan: Springer; 2015. p.6.
Whited RE. A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope. 1984;94(3): p. 367-77.
Miaskiewicz B, Panasiewicz A, Nikiel K, Wlodarczyk E, Gos E, Szkielkowska A. Comparison of 24-month voice outcomes after injection laryngoplasty with calcium hydroxylapatite or hyaluronic acid in patients with unilateral vocal fold paralysis. Am J Otolaryngol. 2022;43(1):103207. doi: 10.1016/j.amjoto.2021.103207.
Zeleník K, Formánek M, Walderová R, Formánková D, Komínek P. Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite. Eur Arch Otorhinolaryngol. 2021;278(4):1139-1144. doi: 10.1007/s00405-020-06479-6.
Lahav Y, Malka-Yosef L, Shapira-Galitz Y, Cohen O, Halperin D, Shoffel-Havakuk H. Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes. Otolaryngol Head Neck Surg. 2021;164(3):631-638. doi: 10.1177/0194599820947000.
Gotxi-Erezuma I, Ortega-Galván M, Laso-Elguezabal A. Laringoplastia de inyección con ácido hialurónico guiada por EMG en etapa precoz de parálisis unilateral de cuerda vocal. Acta Otorrinolaringológica Española. 2017; 68(5):274-283
Kang MG, Seo HG, Chung EJ, Lee HH, Yun SJ, Keam B et al. Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer-related unilateral vocal cord paralysis. Laryngoscope Investig Otolaryngol. 2021;6(4):800-806. doi: 10.1002/lio2.618.
Ryu CH, Kwon TK, Kim H, Kim HS, Park IS, Woo JH et al. Guidelines for the Management of Unilateral Vocal Fold Paralysis From the Korean Society of Laryngology, Phoniatrics and Logopedics. Clin Exp Otorhinolaryngol. 2020;13(4):340-360. doi: 10.21053/ceo.2020.00409.
Wang CC, Wu SH, Tu YK, Lin WJ, Liu SA. Hyaluronic Acid Injection Laryngoplasty for Unilateral Vocal Fold Paralysis-A Systematic Review and Meta-Analysis. Cells. 2020 5;9(11):2417. doi: 10.3390/cells9112417.
Liao LJ, Wang CT. Management of Unilateral Vocal Fold Paralysis after Thyroid Surgery with Injection Laryngoplasty: State of Art Review. Front Surg. 2022 6;9:876228. doi: 10.3389/fsurg.2022.876228.
Lee YC, Pei YC, Lu YA, Chung HF, Li HY, Lee LA et al. Long-Lasting Effect after Single Hyaluronate Injection for Unilateral Vocal Fold Paralysis: Does Concentration Matter? Biomolecules. 2021 26;11(11):1580. doi: 10.3390/biom11111580.
Pan S, Sadoughi B. Effectiveness of Injection Laryngoplasty for Aspiration in Acute Iatrogenic Vocal Fold Paralysis: A Systematic Review. Laryngoscope. 2022;132(4):813-821. doi: 10.1002/lary.29326.
Reder L, Bertelsen C, Angajala V, O'Dell K, Fisher L. Hospitalized Patients With New-Onset Vocal Fold Immobility Warrant Inpatient Injection Laryngoplasty. Laryngoscope. 2021;131(1):115-120. doi: 10.1002/lary.28606.
Mau T, Courey MS. Influence of gender and injection site on vocal fold augmentation. Otolaryngol Head Neck Surg. 2008;138(2):221-5. doi: 10.1016/j.otohns.2007.10.028.
Rapoport , Murry , Woo. Voice assessment of fat injection vs medialization laryngoplasty in nonparalytic dysphonia. Laryngoscope Investig. Otolaryngol. 2021; 53-457.
Marques JAS, Marronnier A, Crampon F, Lagier A, Marie JP. Early Management of Acute Unilateral Vocal Fold Paralysis: Update of the Literature. J Voice. 2021;35(6):924-926. doi: 10.1016/j.jvoice.2020.02.021.
Rapoport SK, Murry T, Woo P. Voice assessment of fat injection vs medialization laryngoplasty in nonparalytic dysphonia. Laryngoscope Investig Otolaryngol. 2021;27;6(3):453-457. doi: 10.1002/lio2.573.
Verma SP, Dailey SH. Office-based injection laryngoplasty for the management of unilateral vocal fold paralysis. J Voice. 2014;28(3):382-6. doi: 10.1016/j.jvoice.2013.10.006.
Filauro M, Vallin A, Fragale M, Sampieri C, Guastini L, Mora F et al. Office-based procedures in laryngology. Acta Otorhinolaryngol Ital. 2021;41(3):243-247. doi: 10.14639/0392-100X-N0935.
Sanabria-Greciano, L., Martínez-Ruiz-Coello, M., Miranda-Sánchez, E., García-García, C., González-Herranz, R., & Plaza-Mayor, G. (2022). Early infiltration in vocal cord paralysis: evolution and predictors. Revista ORL, 14(2), e29825. https://doi.org/10.14201/orl.29825
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