title: Laryngoplasty with hyaluronic acid in patients with unilateral vocal fold paralysis.
abstract: OBJECTIVE
  Augmentation of vocal fold with hyaluronic acid (Restylane; Q-Med AB, Uppsala, Sweden) is used as a therapeutic option for insufficient glottic closure in unilateral vocal fold paralysis (UVP). Analysis of the optimal glottic width, effectiveness (long-term voice improvement as a consequence of longevity of Restylane), and safety of this new method was made.
  
  
  METHODS
  In a prospective clinical cohort study, 19 consecutive patients with UVP who received vocal fold augmentation with hyaluronic acid (Restylane) were examined preoperatively; 6 weeks, 6, and 12 months postoperatively by laryngostroboscopy; and their voice was evaluated by subjective, objective, and self-assessment (Voice Handicap Index).
  
  
  RESULTS
  In 11 of 19 (58%) patients, a subjectively and objectively acceptable voice quality was observed in a follow-up of 12 months. Eight of 19 (42%) patients had a considerable impairment of the voice after 6 weeks (range: 1-24 weeks). Therefore, another intervention (eg, injection laryngoplasty or thyroplasty) was recommended. An impairment of voice was mainly observed if the preoperative glottal gap during phonation was more than 1 mm.
  
  
  CONCLUSIONS
  A long duration (up to 12 months) of acceptable quality of voice was achieved by augmentation with Restylane, if the glottal gap was 1 mm or less videolaryngostroboscopically during phonation. The authors recommend this therapy for temporary voice improvement and to augment vocal therapy, if spontaneous recovery of voice is likely. Long-term results remain to be seen.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Section of Phoniatrics and Pedaudiology, University of Ulm, Ulm, Germany. rudolf.reiter@uniklinik-ulm.de
authors.forename: Rudolf
authors.initials: R
authors.lastname: Reiter
authors.forename: Reiter
authors.initials: R
authors.lastname: Rudolf
authors.forename: Sibylle
authors.initials: S
authors.lastname: Brosch
authors.forename: Brosch
authors.initials: B
authors.lastname: Sibylle
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D007267:Injections; D058753:Laryngoplasty / Q000009:adverse effects / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D013068:Speech Production Measurement; D049489:Stroboscopy; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014827:Vocal Cords / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality
chemical_list: D006820:Hyaluronic Acid; C445361:Restylane