title: Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis--preliminary results.
abstract: OBJECTIVE
  The purpose of this study is to investigate the feasibility of using an injectable needle electrode to guide hyaluronic acid (HA) vocal fold injection (VFI) during laryngeal electromyography (LEMG) for unilateral vocal fold paralysis (UVFP).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  From March to June 2010, 20 UVFP patients received LEMG examination at our clinic. Before completion of LEMG, 1.0 cc of HA (Restylane Perlane(®); Q-Med, Uppsala, Sweden) was injected via a 26-gauge monopolar injectable needle electrode into paralyzed thyroarytenoid muscle. After injection, 20 patients completed 3-months follow-up and 16 patients completed 6-months follow-up. The data before, 1 week, 3 months, and 6 months after injection, including the normalized glottal gap area (NGGA) from videostroboscopy, maximal phonation time (MPT), mean airflow rate (MAFR), phonation quotient (PQ), perceptual evaluation of voice (grade, roughness, breathiness, asthenia, strain [GRBAS] scale), Voice Handicap Index (VHI), and self-grading of choking (grade 1-7), were analyzed by the Wilcoxon signed rank test.
  
  
  RESULTS
  All of the patients completed the procedure without complications. After injection, mean NGGA was significantly reduced from 8.28 units to 0.52 units (1 week), 1.79 units (3 months), and 1.36 units (6 months). The mean MPT was prolonged from 5.66 seconds to 11.73, 11.25, and 11.93 seconds, respectively. VHI was reduced from 76.05 to 38.10, 37.40 and 35.00, respectively. Other analyzed data (PQ, MAFR, GRBAS scale, and choking severity) also showed statistically significant improvement.
  
  
  CONCLUSIONS
  LEMG-guided HA VFI provides UVFP patients with neuromuscular function evaluation and treatment in one step. This clinical technique is feasible, and the short-term results are satisfactory.
authors.affiliation: Department of Medicine, National Yang-Ming University, Taipei, Taiwan. entccwang@msn.com
authors.forename: Chen-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Ming-Hong
authors.initials: MH
authors.lastname: Chang
authors.forename: Ching-Ping
authors.initials: CP
authors.lastname: Wang
authors.forename: Shi-An
authors.initials: SA
authors.lastname: Liu
authors.forename: Kai-Li
authors.initials: KL
authors.lastname: Liang
authors.forename: Shang-Heng
authors.initials: SH
authors.lastname: Wu
authors.forename: Rong-San
authors.initials: RS
authors.lastname: Jiang
authors.forename: Hui-Tsu
authors.initials: HT
authors.lastname: Huang
authors.forename: Hsiu-Chin
authors.initials: HC
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D004566:Electrodes; D004576:Electromyography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D007830:Larynx / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013965:Thyroidectomy / Q000009:adverse effects; D055675:Viscosupplements / Q000008:administration & dosage*; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000628:therapy*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid