Author(s)
Mathieu Bergeron, MD
John Paul Gilberto MD
Meredith E Tabangin , MPH, Alessandro de Alarcon, MD
Affiliation(s)
Ste.Justine Hospital, Montreal, CANADA; University of Cincinnati Hospital Medical Center; University of Cincinnati Children's Hospital
Abstract:
Objectives. Post airway reconstruction dysphonia (PARD) is common and has a significant affect on the quality of life of patients. Vocal fold injection is one treatment that can be used to improve glottic insufficiency in some patients. The goal of this study was to characterize the use and outcomes of vocal fold injection for PARD. Methods. Retrospective chart review from January 2007- July 2018 was performed. All patients had a preinjection voice evaluation and a followup evaluation within 3 months after vocal fold augmentation (fat, carboxymethylcellulose gel, calcium hydroxyapatite) in our interdisciplinary voice clinic. Results. 34 patients (20 female) underwent vocal fold augmentation. The mean age at the time of the injection was 13.6 years (95%CI 11.6-15.7). Twenty patients (58.8%) had a history of prematurity and a mean of 1.8 open airway surgeries (95%CI 1.5-2.1). After injection, 29/34 patients (85.3%) noted a subjective voice improvement. The baseline Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) overall severity score decreased from 62.7 (95%CI 55.3-70.1) to 56.9 (95%CI 49.3-64.5, p<0.12). The total pediatric Voice Handicap Index (pVHI) trended to improve by 6.0 (95%CI 0.6-12.6) points, from 57.4 (95% 50.7-64.1) to 51.4 (95%CI 45.6-57.2, p<0.09). The functional pVHI subscore demonstrated the most improvement, with a decrease of 3.4 points (95%CI 0.9-5.9, p=0.02). All procedures were performed as an overnight observation and no complication occurred after injection. Conclusion. Patients with post-airway reconstruction dysphonia represent a complex subset of patients. Vocal fold injection is a straightforward intervention that may improve voice perception. Many subjects reported subjective improvement despite minimal objective measurement in voice measures. Further work is warranted to elucidate the role of injection in management of PARD.