Abstract
The objective is to compare the long-term voice outcomes of vocal fold augmentation (VFA) using autologous fat injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection. Patients with glottal insufficiency and a gap no greater than 3 mm caused by unilateral vocal fold paralysis or vocal fold atrophy were prospectively recruited to the study from September 2012 to September 2015. From September 2012 to May 2014, VFA was only performed using autologous fat via direct microlaryngoscopy under general anesthesia (N = 14). From May 2014 to September 2015, VFA was performed as an office-based procedure using a transoral approach to inject CaHA (N = 17). Videolaryngostroboscopic evaluation, subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection and 12 months after VFA. A total of 31 patients were analyzed. One year after VFA, 67.8% of the patients were satisfied with their voice, with no significant difference between groups (P = 0.247). The mean improvement in VHI in the autologous fat group was 31.6 ± 16.82 versus 35 ± 27.24 in the CaHA group (P = 0.664). MPT improvement was also similar in the two groups: 5.5 ± 2.52 for the autologous fat group versus 6.0 ± 3.98 for the CaHA group (P = 0.823). Both autologous fat injection via direct microlaryngoscopy and office-based CaHA injection have good long-term results. There were no differences in the treatment results of the two procedures 1 year after injection.
Similar content being viewed by others
References
Benninger MS, Hanick AL, Nowacki AS (2016) Augmentation autologous adipose injections in the larynx. Ann Otol Rhinol Laryngol 125:25–30
Rosen CA, Simpson CB (2008) Operative techniques in laryngology. Springer, Berlin
Mallur PS, Rosen CA (2010) Vocal fold injection: review of indications, techniques, and materials for augmentation. Clin Exp Otorhinolaryngol 3:177–182
Sulica L, Rosen CA, Postma GN et al (2010) Current practice in injection augmentation of the vocal folds: indications, treatment principles, techniques, and complications. Laryngoscope 120:319–325
Rosen CA, Thekdi AA (2004) Vocal fold augmentation with injectable calcium hydroxylapatite: short-term results. J Voice 18:387–391
Rosen CA, Gartner-Schmidt J, Casiano R et al (2011) Vocal fold augmentation with calcium hydroxylapatite: twelve-month report. Laryngoscope 119:1033–1104
Carroll TL, Rosen CA (2011) Long-term results of calcium hydroxylapatite for vocal fold augmentation. Laryngoscope 121:313–319
Mikaelian DO, Lowry LD, Sataloff RT (1991) Lipoinjection for unilateral vocal cord paralysis. Laryngoscope 101:465–468
Dursun G, Boynukalin S, Ozgursoy OB, Coruh I (2008) Long-term results of different treatment modalities for glottic insufficiency. Am J Otolaryngol 29:7–12
Hartl DM, Hans S, Crevier-Buchman L, Vaissière J, Brasnu DF (2009) Long-term acoustic comparison of thyroplasty versus autologous fat injection. Ann Otol Rhinol Laryngol 118:827–832
Hsiung MW, Pai L (2006) Autogenous fat injection for glottic insufficiency: analysis of 101 cases and correlation with patients’ self-assessment. Acta Otolaryngol 126:191–196
Havas TE, Priestley KJ (2003) Autologous fat injection laryngoplasty for unilateral vocal fold paralysis. ANZ J Surg 73:938–943
Fang T-J, Li H-Y, Gliklich RE, Chen YH, Wang PC, Chuang HF (2010) Outcomes of fat injection laryngoplasty in unilateral vocal cord paralysis. Arch Otolaryngol Head Neck Surg 136:457–462
McCulloch TM, Andrews BT, Hoffman HT, Graham SM, Karnell MP, Minnick C (2002) Long-term follow-up of fat injection laryngoplasty for unilateral vocal cord paralysis. Laryngoscope 112(7 Pt 1):1235–1238
Pinto JA, da Silva Freitas ML, Carpes AF, Zimath P, Marquis V, Godoy L (2007) Autologous grafts for treatment of vocal sulcus and atrophy. Otolaryngol Head Neck Surg 137:785–791
Sanderson JD, Simpson CB (2009) Laryngeal complications after lipoinjection for vocal fold augmentation. Laryngoscope 119:1652–1657
Sataloff RT (2010) Autologous fat implantation for vocal fold scar. Curr Opin Otolaryngol Head Neck Surg 18:503–506
Tamura E, Okada S, Shibuya M, Iida M (2010) Comparison of fat tissues used in intracordal autologous fat injection. Acta Otolaryngol 130:405–409
Lodder WL, Dikkers FG (2015) Comparison of voice outcome after vocal fold augmentation with fat or calcium hydroxylapatite. Laryngoscope 125:1161–1165
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was funded by a Conceptual Development of Research Organization grant (MH CZ–DRO–FNOs/2014) from the Ministry of Health of the Czech Republic.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Ethical statement
This article does not contain any studies with animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Zeleník, K., Walderová, R., Kučová, H. et al. Comparison of long-term voice outcomes after vocal fold augmentation using autologous fat injection by direct microlaryngoscopy versus office-based calcium hydroxylapatite injection. Eur Arch Otorhinolaryngol 274, 3147–3151 (2017). https://doi.org/10.1007/s00405-017-4600-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-017-4600-1