Functional assessment of glottal insufficiency treated by hyaluronic acid injection: Retrospective 20-case series

Abstract Objectives The objectives of the present study were to describe hyaluronic acid injection to the vocal folds as treatment for glottal insufficiency, assess indications and report vocal results at 1 month and later than 6 months postoperatively. Patients and methods A single-center retrospective study was performed for the period March 2012 to August 2015. Inclusion criteria comprised: unilateral recurrent nerve palsy or vocal fold closure defect with conserved mobility. Exclusion criteria comprised: previous thyroplasty, severe swallowing disorder, and cognitive disorder hindering subjective vocal assessment. Restylane ® injection was performed under general or local anesthesia. The Vocal Handicap Index (VHI), maximum phonation time (MPT) and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) score were assessed preoperatively and at 1 month and more than 6 months postoperatively. Results Twenty patients were included: 14 with unilateral recurrent nerve palsy and 6 with vocal fold closure defect. Restylane ® injection was performed under general anesthesia in 16 patients and local anesthesia in 4 (20%). At 1-month assessment, there was significant reduction in VHI (by 36 points; P  = 0.0001) and GRBAS score (by 6.95 points; P  = 0.0001) and significant increase in MPT (by 4.95 sec; P  = 0.0001). At 6 months, VHI, MPT and GRBAS scores remained significantly improved (respectively, P  = 0.0002, P  = 0.001 and P  = 0.0001), without significant difference from 1-month levels. Three patients had minor complications; two recovered normal vocal fold mobility. Conclusion Hyaluronic acid injection was effective in treating glottal failure, improving objective and subjective vocal parameters, which remained satisfactory even 6 months postoperatively.