He also noted that “recovery” doesn’t necessarily mean a return to normal vocal fold mobility; it is more important that symptoms improve significantly enough that a patient no longer feels that the surgery is necessary. Some patients do not experience a voice change that is severe or important enough for them to want surgery. “Even when surgeons may perceive the voice as being disordered, we must be careful not to project our biases and conceptions on these patients,” he said. Decisions about management of this condition should be patient centered and not physician centered.
Andrew McWhorter, MD, director of the Louisiana State University Voice Center in Baton Rouge, said that there is a general belief that the earlier an injection augmentation is done, the better the result. But, he said, this may not be true. Published data suggest that injection diminishes the percentage of patients eventually needing framework surgery, but it is debatable whether the timing factors into this outcome.
There is no such thing as a “best” injectable material, he said. “The reason there are so many out there is because none of them have all the best characteristics.” Otolaryngologists should use the material they find to be most reliable in their hands. The goal of the given case also matters—in some, a temporary injectable is preferred; in others, a long-term result is the goal.