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Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections for Glottic Insufficiency.
Ann Otol Rhinol Laryngol. 2020 Nov; 129(11):1063-1070.AO

Abstract

OBJECTIVES

To assess voice outcomes using the novel technique of in-office laryngeal electromyography-guided vocal fold injections (LEVFI) with hyaluronic acid to treat glottal insufficiency. Secondary objectives included determining the complication/completion rates and if any factors were associated with improved voice outcomes.

METHODS

Retrospective review of patients who received their first LEVFI from August 2017 to December 2018. Three- and six-month voice outcomes were assessed. Outcomes included voice handicap index-10 (VHI-10), maximum phonation time (MPT), perceptual analysis of voice (GRBAS), fundamental frequency, and stroboscopy.

RESULTS

Of the 121 eligible patients (55.4% male, age 63.7 years), 94 (77.7%) had complete 3-month data and 59 (48.8%) had complete 6-month data. VHI-10 was significantly improved from 25.7 ± 7.5 to 20.9 ± 10.9 at 3 months (P < .001) and to 19.1 ± 11.5 at 6 months (P < .001). MPT improved from 6.2 ± 5.4 seconds to 9.4 ± 7.1 seconds at 3 months (P < .001) and to 11.3 ± 8.2 seconds at 6 months (P < .001). GRBAS was improved in 74.8% of patients ([65.2, 82.8] 95% CI) at 3 months and 80.8% ([69.9, 89.1]) 95% CI) at 6 months. Stroboscopy showed a glottic gap improvement in 74.8% of patients ([65.8, 82.4] 95% CI) at 3 months and in 80.3% ([65.9, 88.5] 95% CI) at 6 months. Fundamental frequency was unchanged, as expected. Multivariate analysis reported that no factors were associated with better voice outcomes. Overall, 177/181 (97.8%) injections were completed. There were no complications.

CONCLUSION

In-office LEVFI is an effective, novel technique to treat glottic insufficiency with improved voice outcomes, high completion rate, and no significant complications.

Authors+Show Affiliations

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada.School of Population and Public Health, University of British Columbia, Vancouver, Canada.School of Population and Public Health, University of British Columbia, Vancouver, Canada.Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32484033

Citation

Liu, Alice Q., et al. "Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections for Glottic Insufficiency." The Annals of Otology, Rhinology, and Laryngology, vol. 129, no. 11, 2020, pp. 1063-1070.
Liu AQ, Singer J, Lee T, et al. Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections for Glottic Insufficiency. Ann Otol Rhinol Laryngol. 2020;129(11):1063-1070.
Liu, A. Q., Singer, J., Lee, T., & Hu, A. (2020). Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections for Glottic Insufficiency. The Annals of Otology, Rhinology, and Laryngology, 129(11), 1063-1070. https://doi.org/10.1177/0003489420931556
Liu AQ, et al. Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections for Glottic Insufficiency. Ann Otol Rhinol Laryngol. 2020;129(11):1063-1070. PubMed PMID: 32484033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections for Glottic Insufficiency. AU - Liu,Alice Q, AU - Singer,Joel, AU - Lee,Terry, AU - Hu,Amanda, Y1 - 2020/06/02/ PY - 2020/6/3/pubmed PY - 2020/6/3/medline PY - 2020/6/3/entrez KW - glottal insufficiency KW - hyaluronic acid KW - laryngology KW - vocal fold injections KW - vocal fold paralysis SP - 1063 EP - 1070 JF - The Annals of otology, rhinology, and laryngology JO - Ann Otol Rhinol Laryngol VL - 129 IS - 11 N2 - OBJECTIVES: To assess voice outcomes using the novel technique of in-office laryngeal electromyography-guided vocal fold injections (LEVFI) with hyaluronic acid to treat glottal insufficiency. Secondary objectives included determining the complication/completion rates and if any factors were associated with improved voice outcomes. METHODS: Retrospective review of patients who received their first LEVFI from August 2017 to December 2018. Three- and six-month voice outcomes were assessed. Outcomes included voice handicap index-10 (VHI-10), maximum phonation time (MPT), perceptual analysis of voice (GRBAS), fundamental frequency, and stroboscopy. RESULTS: Of the 121 eligible patients (55.4% male, age 63.7 years), 94 (77.7%) had complete 3-month data and 59 (48.8%) had complete 6-month data. VHI-10 was significantly improved from 25.7 ± 7.5 to 20.9 ± 10.9 at 3 months (P < .001) and to 19.1 ± 11.5 at 6 months (P < .001). MPT improved from 6.2 ± 5.4 seconds to 9.4 ± 7.1 seconds at 3 months (P < .001) and to 11.3 ± 8.2 seconds at 6 months (P < .001). GRBAS was improved in 74.8% of patients ([65.2, 82.8] 95% CI) at 3 months and 80.8% ([69.9, 89.1]) 95% CI) at 6 months. Stroboscopy showed a glottic gap improvement in 74.8% of patients ([65.8, 82.4] 95% CI) at 3 months and in 80.3% ([65.9, 88.5] 95% CI) at 6 months. Fundamental frequency was unchanged, as expected. Multivariate analysis reported that no factors were associated with better voice outcomes. Overall, 177/181 (97.8%) injections were completed. There were no complications. CONCLUSION: In-office LEVFI is an effective, novel technique to treat glottic insufficiency with improved voice outcomes, high completion rate, and no significant complications. SN - 1943-572X UR - https://www.unboundmedicine.com/medline/citation/32484033/Laryngeal_Electromyography_Guided_Hyaluronic_Acid_Vocal_Fold_Injections_for_Glottic_Insufficiency_ L2 - https://journals.sagepub.com/doi/10.1177/0003489420931556?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -