A meta-analysis of voice outcome comparing calcium hydroxylapatite injection laryngoplasty to silicone thyroplasty.
OBJECTIVE
To compare the voice outcome of calcium hydroxylapatite (CaHA) injection laryngoplasty (IL) vs silicone medialization thyroplasty (MT) in the treatment of unilateral vocal fold paralysis (UVFP).


METHODS
Systematic review of English literature from MEDLINE, Google Scholar, Web of Science, Scopus, and the Cochrane library from January 1, 1980, to December 31, 2010.


METHODS
Included studies reporting voice-related quality of life (Voice Handicap Inventory [VHI]) following IL with CaHA or MT with silicone. The primary outcome measure was the improvement in VHI. The secondary outcome was improvement in maximum phonatory time (MPT).


RESULTS
Of the 742 abstracts screened for relevancy, 24 studies qualified for analysis. The mean (SD) VHI scores were 72.22 (11.06) before MT and 34.02 (6.48) after MT. The mean (SD) VHI scores were 68.36 (6.88) before IL and 32.24 (7.33) after IL. The paired difference mean of VHI improvement was 38.20 (95% confidence interval [CI], 17.05-59.32; P = .007) for MT and 36.11 (95% CI, 29.65-42.57; P = .001) for IL. The mean (SD) MPT scores were 7.40 (3.14) before IL and 13.00 (1.75) after IL. The mean (SD) MPT scores were 6.16 (1.90) before MT and 12.40 (2.72) after MT. The paired difference mean of MPT improvement was 6.23 (95% CI, 4.74-7.73; P < .001) for MT and 5.60 (95% CI, 2.95-8.25; P = .006) for IL.


CONCLUSIONS
Injection laryngoplasty with CaHA and MT with silicone appear to achieve comparable voice improvement within 1 year, but a definitive conclusion is limited by a lack of standardized outcome measures.
Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, California 94305-5739, USA. tshen@stanford.edu
Tianjie
T
Shen
Edward J
EJ
Damrose
Sanjay
S
Morzaria
D017886:Durapatite / Q000008:administration & dosage / Q000627:therapeutic use*; D005931:Glottis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007267:Injections; D058753:Laryngoplasty / Q000379:methods*; D010699:Phonation; D011788:Quality of Life; D012828:Silicones / Q000008:administration & dosage / Q000627:therapeutic use*; D014826:Vocal Cord Paralysis / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality
D012828:Silicones; D017886:Durapatite