Easier-to-Use Vocal Fold Injectables Prompt More In-Office Procedures

Armed with an arsenal of newer, easier-to-use injection materials, many otolaryngologists-head and neck surgeons are treating patients with vocal fold insufficiencies in their own offices, avoiding the hassle and expense of going to the operating room.

Since 1980, at least eight materials-all of which can be injected in the outpatient setting-have been introduced for vocal fold augmentation, said Dale P. DeVore, PhD, Vice President of Research and Development at BioForm Medical, Inc., of San Mateo, CA, which develops and markets injectable products.

The office-based outpatient setting is particularly appropriate for temporary treatment of vocal fold insufficiency, typically performed when the prognosis is unknown, when a return of laryngeal nerve function is expected, or as a bridge to surgery, specialists say. But permanent vocal fold injections are being performed more frequently in the outpatient setting as well.

Among the conditions that can be treated with in-office injectables are unilateral vocal fold paralysis, vocal fold paresis, vocal fold atrophy, vocal fold scarring, vocal fold weakness or bowing, and spasmodic dysphonia.

C. Gaelyn Garrett, MD, Medical Director of the Vanderbilt Voice Center and Associate Professor in the Department of Otolaryngology at Vanderbilt University School of Medicine in Nashville, Tenn., said the most common reason she turns to injectables is for temporary treatment of patients with unilateral vocal fold paralysis.

My preference is for temporary augmentation, as none of the available injectables gives me the long-term results I would like to see. Then I use a different procedure-that is, surgery-for more permanent results, she said.

In patients with bowing, Dr. Garrett said she uses bilateral injections as a test to determine if adding bulk will improve voice. If it works, she then proceeds to a bilateral thyroplasty; if it does not, she said she then knows not to do anything aggressive.

Gary Y. Shaw, MD, Medical Director of the Voice and Swallowing Care Center at Research Medical Center in Kansas City and Associate Professor of Surgery at the Kansas City University of Biomedical and Health Sciences, said he primarily performs in-office procedures for patients with vocal cord atrophy or paresis.

If someone has paralysis, injectables are good for fine-tuning, but you really need an implant, usually with silicone, which requires a surgical procedure, he said. The implants are hard, not soft like the fillers.

The in-office procedure is relatively simple: After the airway is topically anesthetized, the affected vocal fold is injected with a resorbable material under endoscopic guidance. The injected material reduces the gap between the vocal cords so that they can make closer contact with one another, thereby improving vocal function.