title: Safety and efficacy of carboxymethylcellulose in the treatment of glottic insufficiency.
abstract: OBJECTIVE
  No studies to date have examined the clinical safety and efficacy of carboxymethylcellulose (CMC) for vocal fold injection. The current study investigates the voice outcomes and complications of CMC injection.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  All patients who underwent CMC injection from three independent sites in a 1-year period were reviewed. Voice outcomes in the form of voice handicap index-10 (VHI-10) and complications from injection were recorded.
  
  
  RESULTS
  Seventy-eight patients with VHI-10 results from 1 to 8 weeks after CMC injection were evaluated. Thirty-eight patients were treated for vocal fold immobility, and 15 patients underwent treatment for hypomobility, 15 for vocal fold atrophy, seven for scar/sulcus, one for previous laryngeal fracture, one for functional dysphonia, and one for persistent granuloma. In 60 patients with available VHI-10 data, overall improvement in voice was seen. There was a mean decrease in VHI-10 of 7.48 (26.4 to 18.9, P < .05), correlating to a 19.9% decrease. Forty-five patients (75%) showed a decrease in VHI-10, nine (15%) showed an increase, and six (10%) showed no change. Statistically significant differences were seen for patients with immobility (decrease of 8.6, or 31%) and hypomobility (decrease of 10.7, or 37.8%). There were no complications of vocal fold stiffness, inflammatory reaction, or scar in the 78 patients during the total follow-up period.
  
  
  CONCLUSIONS
  CMC is a viable, safe, and efficacious material for the temporary treatment of glottic insufficiency in vocal fold immobility and hypomobility, with minimal risk of permanent adverse voice outcomes.
authors.affiliation: Department of Surgery, Division of Otolaryngology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Pavan S
authors.initials: PS
authors.lastname: Mallur
authors.forename: Michele P
authors.initials: MP
authors.lastname: Morrison
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Postma
authors.forename: Milan R
authors.initials: MR
authors.lastname: Amin
authors.forename: Clark A
authors.initials: CA
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002480:Cellulase / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000503:physiopathology*; D006801:Humans; D007267:Injections; D007818:Laryngeal Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014827:Vocal Cords; D014831:Voice; D014833:Voice Quality; D055815:Young Adult
chemical_list: D002480:Cellulase; C019826:carboxymethylcellulase