Trial Vocal Fold Injection Helps Predict Positive Outcomes

The primary outcome measure for Dr. Carroll’s study was the patients’ perception of voice after the trial injection. A patient’s self-reported voice satisfaction was obtained from follow-up clinic notes. Subjective outcome was rated as either good, partial, or poor.

Eight patients reported a completely satisfactory or good result and 11 patients reported somewhat improved or partial results, he said. Of these 19 patients, nine went on to permanent augmentation.

Six of the 25 patients had a poor outcome after their trial injection, with only one of these patients proceeding on to a permanent procedure. This one patient was found to have a significant muscle tension dysphonia requiring multiple Botox injections before a permanent injection was performed, he said.

Overall, 10 patients went on to a permanent procedure, Dr. Carroll said. The trial injection numbers reveal that a better result more often leads to the patient going on to a permanent augmentation. All patients who eventually went on to a permanent procedure had a good subjective final result.

The change in average Voice Handicap Index (VHI-10) score between pretrial and post-permanent treatment time points was statistically significant, he said. The average pretrial VHI-10 score was 22.3, whereas the average post-permanent treatment VHI-10 score was 13.1 (p = 0.002).

A Good Option

Injection of a vocal fold with a temporary or slowly resorbed material such as VoiceGel is a good option early after the onset of vocal fold paralysis, when recovery of nerve function and consequent vocal fold motion is still possible, said Robert W. Bastian, MD, founder of the Bastian Voice Institute in Downers Grove, IL. If the paralysis is known to be permanent, then a permanent implant would seem to be more logical.

Dr. Bastian, also Clinical Professor of Otolaryngology at Loyola University Medical Center in Maywood, IL, added that infrequently, an individual balks at a permanent implant, even though this is clinically indicated. Or, as noted, the potential for benefit is debatable despite careful evaluation of voice and larynx function. While these circumstances are not very common, a trial, using a temporary material, would seem to be an option to hold.

©2008 The Triological Society