Cross-linked hyaluronan used as augmentation substance for treatment of glottal insufficiency: safety aspects and vocal fold function.
OBJECTIVE
To examine safety aspects and vocal fold function after vocal fold augmentation with a cross-linked hyaluronan derivative (hylan B gel) as compared with bovine collagen. STUDY DESIGN; A prospective, randomized trial.


METHODS
Eighty-three patients with glottal insufficiency were treated with injection augmentation with hylan B gel and bovine collagen and were examined at 1, 6, and 12 months after treatment. Seventy patients with unilateral vocal fold paresis (n = 35) or atrophy (n = 35) were randomly assigned to receive either hylan B gel (n = 47) or collagen (n = 23) injections into one vocal fold. Thirteen patients with glottal insufficiency caused by scar defects or paresis resulting from malignant disease were included in a nonrandomized group and were treated only with hylan B gel. Evaluations were made from patients' subjective ratings (visual analogue scales), digitized videostroboscopic measurements, phonetograms, maximum phonation time, and phonation quotients.


RESULTS
Twelve months after injections, the patients' self-ratings were significantly improved for both the hylan B gel and the collagen groups. In addition, the videostroboscopic measurements showed significantly improved glottal closure for both groups. However, for the hylan B gel group, vibration amplitude and glottal area variations were preserved, and this group showed significantly less resorption at the injected vocal fold edge. Furthermore, maximum phonation time had increased significantly for the hylan B gel patients (collagen, nonsignificant). No serious adverse events were observed; three patients injected with hylan B gel had temporary inflammation at the injection site, which resolved without sequelae.


CONCLUSIONS
The results showed that both hylan B gel and collagen can be safely used for injection treatment of glottal insufficiency. Both treatments resulted in significantly improved voice as rated by the patients. However, the patients treated with hylan B gel showed better vocal fold status and longer maximum phonation time at 12 months after treatment as compared with patients treated with collagen.
Hertegård
Stellan
S
Department of Logopedics and Phoniatrics, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden. Stellan.Hertegard@klinvet.ki.se
Hallén
Lars
L
Laurent
Claude
C
Lindström
Elisabeth
E
Olofsson
Katarina
K
Testad
Per
P
Dahlqvist
Ake
A
D000368:Aged; D000818:Animals; D002417:Cattle; D002482:Cellulose / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D004338:Drug Combinations; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006584:Hexamethonium Compounds / Q000627:therapeutic use*; D006801:Humans; D006820:Hyaluronic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D012449:Safety; D013635:Tantalum / Q000627:therapeutic use*; D013917:Thrombin / Q000627:therapeutic use*; D013997:Time Factors; D014826:Vocal Cord Paralysis / Q000628:therapy*; D014827:Vocal Cords / Q000503:physiopathology*
D004338:Drug Combinations; D006584:Hexamethonium Compounds; C070509:hylan gel; D013635:Tantalum; D002482:Cellulose; D006820:Hyaluronic Acid; D003094:Collagen; D013917:Thrombin