Posterior Pharyngeal Wall Injection Appears Effective for Some Adults with Non-Cleft Velopharyngeal Dysfunction

CLINICAL QUESTION

What is the impact of posterior pharyngeal wall (PPW) injection on the severity of dysphagia and dysphonia in the treatment of velopharyngeal deficiency (VPD)?

BOTTOM LINE

Posterior pharyngeal wall injection appears to have a therapeutic effect on dysphagia and dysphonia in patients with VPD.

BACKGROUND: Velopharyngeal dysfunction refers to a spectrum of etiologies that prevent closure of the velopharyngeal sphincter. Well defined in literature as a treatment for pediatric velopharyngeal insufficiency (VPI), PPW has been reported as a viable treatment for VPD in the non-cleft adult population as well, but data on safety, efficacy, and patient criteria are lacking.

STUDY DESIGN: Retrospective study

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, Calif.

SYNOPSIS: Researchers conducted a chart review of 29 adult patients (18 males, mean age 59.4 years) with non-cleft VPD undergoing PPW augmentation from February 2018 to August 2023 at a single institution. A total of 67 injections were performed, 30 of which were concurrent with intervention on the upper esophageal sphincter and eight with a glottic procedure. The severity of symptoms at initial and subsequent visits was assessed using change scores from Effects on Voice Handicap Index-10 (VHI-10) and Eating Assessment Tool-10 (EAT-10), soft palate closure on modified barium swallow, and analysis of auditory–perceptual measures of hypernasality and audible nasal air emission. Forty-eight injections had pre- and post-procedure scores for analysis. Auditory–perceptual measures of hypernasality and audible nasal air emission both improved significantly. Change scores for VHI-10 and EAT-10 were –3.87 and –3.00, respectively. Subgroup analysis showed more significant change scores for patients who did not undergo combined procedures, but given the many patients who have multifactorial impairment, the authors note that additional study is needed to determine the benefit of PPW in this population. Study limitations included reliance on clinical judgment for determining the presence of VPD.

CITATION: Arora N, et al. Efficacy of posterior pharyngeal wall injection for velopharyngeal dysfunction in adults. Laryngoscope. 2025;135:605-613. doi:10.1002/lary.31788.