Silastic and Gore-Tex Implants Provide Similar Improvements in Patients Receiving TT1 for Unilateral Vocal Fold Immobility

CLINICAL QUESTION

How do Silastic (silicone) and Gore-Tex implants compare in terms of outcome in patients receiving type 1 thyroplasty (TT1) for unilateral vocal fold immobility?

BOTTOM LINE

Silicone and Gore-Tex implants both provide adequate and comparable results in TT1.

BACKGROUND: Type 1 thyroplasty is a well-established procedure for medializing an immobile vocal fold, using nonabsorbable materials to achieve long-term or permanent results. There is variability in implant selection among surgeons who perform TT1: While Silastic and Gore-Tex are the most common materials used, comparative data on their relative efficacy are scarce.

STUDY DESIGN: Systematic review

SETTING: Department of Otolaryngology–Head and Neck Surgery, UT Health Houston–McGovern Medical School, Houston

SYNOPSIS: Researchers evaluated common voice and surgical outcomes between specific implant groups in patients with unilateral vocal fold immobility who underwent TT1. Fifty-five records were included in their review, with 41 unique studies comprising 1,038 patients receiving Silastic implants, and 13 unique studies comprising 245 patients receiving Gore-Tex implants. Data collected included maximum phonation time (MPT) and voice handicap index scores (VHI-10 and VHI-30). The pooled mean increase in MPT for Silastic patients was 7.8 s, compared with 5.7 s for Gore-Tex. Publications within the MPT analysis had significant flaws, including missing data. The pooled mean change in VHI-30 with Silastic was –45.4 (62.2%) compared with –51.6 (73.5%) with Gore-Tex. The pooled mean change in VHI-10 with Silastic was –15.6 (54%) compared with –11.6 (42%) with Gore-Tex. There was no significant publication bias present in VHI outcomes. Although neither material showed a significant difference over the other in ability to significantly increase MPT and decrease VHI scores, the authors note that future investigations into the structural changes of vocal fold shape and position over time following TT1 with either Silastic or Gore-Tex would likely shed light on the relative value of these material properties. Study limitations included a lack of standardization of included studies.

CITATION: Vance DG, et al. Systematic review and meta-analysis of outcomes in type 1 thyroplasty comparing Silastic to Gore-Tex. Laryngoscope. 2025;135:1236-1247. doi.org/10.1002/lary.31867.

COMMENT: This study performs a meta-analysis of patient outcomes following type 1 thyroplasty with either Gore-Tex or Silastic implants. These two implant types are the most commonly used for this procedure, and there is much debate about which version is superior for long-term outcomes. The study shows equivalent outcomes in comparison with published studies. —Jonathan Bock, MD.