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Open Access 06-09-2024 | Dysphonia | Laryngology

Predictors of injection laryngoplasty volume for glottic insufficiency

Authors: Ariel Roitman, Anumitha Venkatraman, Susan Thibeault

Published in: European Archives of Oto-Rhino-Laryngology

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Abstract

Purpose

Volume injected for glottic insufficiency is paramount in achieving desired outcome. Factors that determine the required volume have not been thoroughly investigated and may correlate with outcome. The first objective of this investigation was to evaluate the association between injectable volume and various parameters, including lifestyle characteristics, pre-procedural factors, and voice measures, while the second aim assessed the correlation of volume to clinical outcomes in patients who underwent injection laryngoplasty.

Methods

For the first objective, a one-way ANOVA and univariate linear regression were used to analyze data from 124 patients (injected material, pre-operative diagnosis, previous voice therapy, age etc.). One-sample t-tests and Pearson correlational coefficients were employed for statistical analysis of aim 2 in a subgroup of 28 patients that had pre- and post-injection voice evaluations (e.g., acoustic and aerodynamic analysis, perceptual assessment, questionnaires).

Results

Average injection volume was 0.39 ± 0.062 mL (range: 0.1–1.6mL). No pre-procedural or lifestyle factor significantly affected injection volume (p > 0.05). There was no relationship between pre-procedural voice outcomes and injection volume (p > 0.05). Of the factors that were significantly improved post-injection laryngoplasty (GFI, VHI, and GRBAS), there were no significant correlations between the magnitude of improvement in these measures and injection volume (p > 0.05).

Conclusion

Injection volume does not appear to be affected by pre-procedural or lifestyle factors. In addition, injection volume does not significantly impact clinical outcomes assessed through voice analysis or patient-reported questionnaires. Our results underscore the complexity of factors at play in injection laryngoplasty for glottic insufficiency.
Literature
2.
go back to reference Granato F, Martelli F, Comini LV, Luparello P, Coscarelli S, Le Seac O, Carucci S, Graziani P, Santoro R, Alderotti G, Barillari MR, Mannelli G (2019) The surgical treatment of unilateral vocal cord paralysis (UVCP): qualitative review analysis and meta-analysis study. Eur Arch Otorhinolaryngol 276(10):2649–2659. https://doi.org/10.1007/s00405-019-05587-2Epub 2019 Aug 2. PMID: 31375895CrossRefPubMed Granato F, Martelli F, Comini LV, Luparello P, Coscarelli S, Le Seac O, Carucci S, Graziani P, Santoro R, Alderotti G, Barillari MR, Mannelli G (2019) The surgical treatment of unilateral vocal cord paralysis (UVCP): qualitative review analysis and meta-analysis study. Eur Arch Otorhinolaryngol 276(10):2649–2659. https://​doi.​org/​10.​1007/​s00405-019-05587-2Epub 2019 Aug 2. PMID: 31375895CrossRefPubMed
5.
go back to reference Young VN, Gartner-Schmidt J, Rosen CA (2015) Comparison of voice outcomes after trial and long-term vocal fold augmentation in vocal fold atrophy. Laryngoscope. ;125(4):934 – 40. https://doi.org/10.1002/lary.25043. Epub 2015 Feb 3. PMID: 25646841 Young VN, Gartner-Schmidt J, Rosen CA (2015) Comparison of voice outcomes after trial and long-term vocal fold augmentation in vocal fold atrophy. Laryngoscope. ;125(4):934 – 40. https://​doi.​org/​10.​1002/​lary.​25043. Epub 2015 Feb 3. PMID: 25646841
7.
go back to reference Nassimizadeh A, El-Shummar S, Emery K, Costello D (2020) Vocal fold medialization-A 5-year series of single surgeon consecutive medialization with review of literature. J Eval Clin Pract. ;26(1):281–289. https://doi.org/10.1111/jep.13169. Epub 2019 Jun 5. PMID: 31168894 Nassimizadeh A, El-Shummar S, Emery K, Costello D (2020) Vocal fold medialization-A 5-year series of single surgeon consecutive medialization with review of literature. J Eval Clin Pract. ;26(1):281–289. https://​doi.​org/​10.​1111/​jep.​13169. Epub 2019 Jun 5. PMID: 31168894
9.
go back to reference Lin WY, Chang WD, Ko LW, Tsou YA, Chen SH (2020) Impact of patient-related factors on successful autologous fat injection laryngoplasty in thyroid surgical treated related unilateral vocal fold paralysis- observational study. Medicine (Baltimore). ;99(1):e18579. doi: 10.1097/MD.0000000000018579. Erratum in: Medicine (Baltimore). 2020;99(7):e19406. PMID: 31895805; PMCID: PMC6946487 Lin WY, Chang WD, Ko LW, Tsou YA, Chen SH (2020) Impact of patient-related factors on successful autologous fat injection laryngoplasty in thyroid surgical treated related unilateral vocal fold paralysis- observational study. Medicine (Baltimore). ;99(1):e18579. doi: 10.1097/MD.0000000000018579. Erratum in: Medicine (Baltimore). 2020;99(7):e19406. PMID: 31895805; PMCID: PMC6946487
11.
go back to reference Ballard DP, Abramowitz J, Sukato DC, Bentsianov B, Rosenfeld RM (2018) Systematic Review of Voice Outcomes for Injection Laryngoplasty Performed under local vs General Anesthesia. Otolaryngol Head Neck Surg 159(4):608–614 Epub 2018 Jul 10. PMID: 29989849CrossRefPubMed Ballard DP, Abramowitz J, Sukato DC, Bentsianov B, Rosenfeld RM (2018) Systematic Review of Voice Outcomes for Injection Laryngoplasty Performed under local vs General Anesthesia. Otolaryngol Head Neck Surg 159(4):608–614 Epub 2018 Jul 10. PMID: 29989849CrossRefPubMed
12.
go back to reference Miyata E, Miyamoto M, Shiromoto O, Kobayashi Y, Yagi M, Kitawaki T, Kawaura T, Tomoda K, Iwai H (2020 Nov-Dec) Early voice therapy for unilateral vocal Fold paralysis improves subglottal pressure and glottal closure. Am J Otolaryngol 41(6):102727 Epub 2020 Sep 13. PMID: 32979665 Miyata E, Miyamoto M, Shiromoto O, Kobayashi Y, Yagi M, Kitawaki T, Kawaura T, Tomoda K, Iwai H (2020 Nov-Dec) Early voice therapy for unilateral vocal Fold paralysis improves subglottal pressure and glottal closure. Am J Otolaryngol 41(6):102727 Epub 2020 Sep 13. PMID: 32979665
14.
go back to reference Birkent H, Sardesai M, Hu A, Merati AL (2013) Prospective study of voice outcomes and patient tolerance of in-office percutaneous injection laryngoplasty. Laryngoscope. ;123(7):1759-62. https://doi.org/10.1002/lary.24010. Epub 2013 Apr 18. PMID: 23606269 Birkent H, Sardesai M, Hu A, Merati AL (2013) Prospective study of voice outcomes and patient tolerance of in-office percutaneous injection laryngoplasty. Laryngoscope. ;123(7):1759-62. https://​doi.​org/​10.​1002/​lary.​24010. Epub 2013 Apr 18. PMID: 23606269
15.
go back to reference Dorbeau C, Marmouset F, Lescanne E, Bakhos D, Morinière S (2017) Functional assessment of glottal insufficiency treated by hyaluronic acid injection: retrospective 20-case series. Eur Ann Otorhinolaryngol Head Neck Dis 134(3):145–149 Epub 2016 Dec 20. PMID: 28007508CrossRefPubMed Dorbeau C, Marmouset F, Lescanne E, Bakhos D, Morinière S (2017) Functional assessment of glottal insufficiency treated by hyaluronic acid injection: retrospective 20-case series. Eur Ann Otorhinolaryngol Head Neck Dis 134(3):145–149 Epub 2016 Dec 20. PMID: 28007508CrossRefPubMed
17.
go back to reference Chow XH, Johari SF, Rosla L, Wahab AFA, Azman M, Baki MM (2021) Early transthyrohyoid injection Laryngoplasty under local Anaesthesia in a single Tertiary Center of Southeast Asia: Multidimensional Voice outcomes. Turk Arch Otorhinolaryngol 59(4):271–281. https://doi.org/10.4274/tao.2021.2021-8-12Epub 2022 Feb 22. PMID: 35262044; PMCID: PMC8864197CrossRefPubMed Chow XH, Johari SF, Rosla L, Wahab AFA, Azman M, Baki MM (2021) Early transthyrohyoid injection Laryngoplasty under local Anaesthesia in a single Tertiary Center of Southeast Asia: Multidimensional Voice outcomes. Turk Arch Otorhinolaryngol 59(4):271–281. https://​doi.​org/​10.​4274/​tao.​2021.​2021-8-12Epub 2022 Feb 22. PMID: 35262044; PMCID: PMC8864197CrossRefPubMed
20.
go back to reference Umeno H, Tanaka HI, Kurita T, Mihashi R, Chitose SI, Sato K (2022) Long-Term Effects of Fat Injection Laryngoplasty in Relation to the Injected Fat Volume in Patients With Unilateral Vocal Fold Paralysis. J Voice. Sep 17:S0892-1997(22)00260-0. doi: 10.1016/j.jvoice.2022.08.020. Epub ahead of print. PMID: 36127213 Umeno H, Tanaka HI, Kurita T, Mihashi R, Chitose SI, Sato K (2022) Long-Term Effects of Fat Injection Laryngoplasty in Relation to the Injected Fat Volume in Patients With Unilateral Vocal Fold Paralysis. J Voice. Sep 17:S0892-1997(22)00260-0. doi: 10.1016/j.jvoice.2022.08.020. Epub ahead of print. PMID: 36127213
21.
go back to reference Wang CC, Chang MH, Wang CP, Liu SA, Liang KL, Wu SH, Jiang RS, Huang HT, Lai HC (2012) Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal Fold paralysis–preliminary results. J Voice 26(4):506–514 Epub 2011 Aug 4. PMID: 21816569CrossRefPubMed Wang CC, Chang MH, Wang CP, Liu SA, Liang KL, Wu SH, Jiang RS, Huang HT, Lai HC (2012) Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal Fold paralysis–preliminary results. J Voice 26(4):506–514 Epub 2011 Aug 4. PMID: 21816569CrossRefPubMed
22.
go back to reference Wang CC, Chang MH, Jiang RS, Lai HC, De Virgilio A, Wang CP, Wu SH, Liu SA, Liang KL (2015) Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis: a prospective long-term follow-up outcome report. JAMA Otolaryngol Head Neck Surg. ;141(3):264 – 71. https://doi.org/10.1001/jamaoto.2014.3466. PMID: 25590517 Wang CC, Chang MH, Jiang RS, Lai HC, De Virgilio A, Wang CP, Wu SH, Liu SA, Liang KL (2015) Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis: a prospective long-term follow-up outcome report. JAMA Otolaryngol Head Neck Surg. ;141(3):264 – 71. https://​doi.​org/​10.​1001/​jamaoto.​2014.​3466. PMID: 25590517
23.
go back to reference Gotxi-Erezuma I, Ortega-Galán M, Laso-Elguezabal A, Prieto Puga G, Bullido-Alonso C, García-Gutiérrez S, Anton-Ladislao A, Moreno-Alonso E (2017) Sep-Oct;68(5):274–283 Electromyography-guided hyaluronic acid injection laryngoplasty in early stage of unilateral vocal fold paralysis. Acta Otorrinolaringol Esp (Engl Ed). English, Spanish. https://doi.org/10.1016/j.otorri.2016.12.001. Epub 2017 Feb 24. PMID: 28238367 Gotxi-Erezuma I, Ortega-Galán M, Laso-Elguezabal A, Prieto Puga G, Bullido-Alonso C, García-Gutiérrez S, Anton-Ladislao A, Moreno-Alonso E (2017) Sep-Oct;68(5):274–283 Electromyography-guided hyaluronic acid injection laryngoplasty in early stage of unilateral vocal fold paralysis. Acta Otorrinolaringol Esp (Engl Ed). English, Spanish. https://​doi.​org/​10.​1016/​j.​otorri.​2016.​12.​001. Epub 2017 Feb 24. PMID: 28238367
Metadata
Title
Predictors of injection laryngoplasty volume for glottic insufficiency
Authors
Ariel Roitman
Anumitha Venkatraman
Susan Thibeault
Publication date
06-09-2024
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-024-08908-2