Platelet-Rich Plasma Injections Promising Treatment Option for Patients with Vocal Fold Scar and Sulcus

by Linda Kossoff •

CLINICAL QUESTION

What are the potential benefits of serial platelet-rich plasma (PRP) injections on mucosal wave restoration and vocal function in patients with vocal fold scar and sulcus?

BOTTOM LINE

  PRP injections resulted in improved patient-reported outcome measures and auditory–perceptual measures of voice and are a promising treatment option for vocal fold scar and sulci.

BACKGROUND: Superficial lamina propria (SLP) layer abnormalities are challenging to treat, largely due to the inability to reproduce the pliable nature of the SLP once it is deficient. PRP has been shown to aid tissue regeneration in other areas of medicine and may be a potential treatment for SLP layer abnormalities.

STUDY DESIGN: Prospective study

SETTING: USC Voice Center, Caruso Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles

SYNOPSIS: In a clinical trial across two institutions, 15 adult patients (12 males; mean age 64.2 years) with a diagnosis of vocal fold scar or sulcus received a series of four unilateral PRP injections administered one month apart. Eight patients had mild, three had moderate, and four had severe scarring. Videostroboscopy examination videos were created for all subjects. Blinded independent laryngologists and expert listeners used pre-treatment and post-fourth injection videostroboscopy and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) assessments to evaluate mucosal wave and voice quality changes, respectively. Patient-reported outcome measures were evaluated. Results showed an average reduction of 8.7 points in post-treatment VHI (Voice Handicap Index)-10 scores. The raters observed an improvement in post-treatment voice in 73.4% of cases, and CAPE-V scores showed a reduction of 18.8 points on average. The videostroboscopic Voice–Vibratory Assessment with Laryngeal Imaging ratings showed an improvement in mucosal wave rating from 2.0 to 4.0, which authors note is still not necessarily considered normal. The severity of scar was not associated with any difference in outcomes. On average, the raters perceived the post-PRP exams to be better in 56.7% of cases. Study limitations included lack of long-term evaluation of efficacy.

CITATION: Santa Maria C, et al. Prospective outcomes after serial platelet-rich plasma (PRP) injection in vocal fold scar and sulcus. Laryngoscope. 2024;134(12):5021–5027. doi.org/10.1002/lary.31683