Dr. Merati said the case was more about the virtues of patience than the virtues of EMG. “I would argue that the conclusion shouldn’t be that we should be doing EMGs, but rather that not rushing in to do open surgery is the core of the conclusion,” he said. “If you’re doing augmentation observation, you’re getting to the same place.”
Explore this issue:April 2017
Office Injection Timing
Panelists also discussed timing office injections for patients with vocal fold paralysis. “I love office injections, and I do them pretty much immediately in most people,” Dr. Kost said. “If somebody comes in and doesn’t have any contraindications to an injection, has significant morbidity from their voice, which many patients do—most do, in fact—we have a very, very low threshold for doing an injection to start off with.”
Dr. Merati said he would hesitate in certain cases. “I’m a little hesitant on some of these cases if a patient is going to get framework surgery,” he said. “I don’t love doing framework surgery after there’s been an injection as much as I love doing framework surgery when there’s not been an injection.”
Dr. Sataloff said counseling the patient is important. “I have a long talk with people and tell them that if they’re going to want something definitive, the injection may delay when they can have it,” he said.
The panelists said that they almost never use hydroxylapetite anymore, and most expressed a preference for some form of hyaluronic acid.
They were somewhat split on their use of autologous fat injections. Dr. Benninger said an advantage is that its visco-elastic properties are similar to those of the vocal folds. “The problem with fat is that you have to overinject, and it’s somewhat unpredictable,” he sad. “You get about half the patients where you get a good result and half where you don’t.”
Dr. Kost said her use of fat is fairly uncommon, just because of the convenience of the injectables that are currently available. “I only use fat if patients ask for it, or we do have those patients who come in who just don’t want anything artificial injected in their larynx.”
Dr. Sataloff said the results with fat injections, though not appropriate for all patients, can be long lasting. “It has the potential to be permanent,” he said. “We have people more than 20 years out with one or two injections.”
Thomas Collins is a freelance medical writer based in Florida.