title: Effect of injection augmentation on need for framework surgery in unilateral vocal fold paralysis.
abstract: OBJECTIVE
  To determine whether injection augmentation reduces the likelihood of ultimately needing definitive framework surgery in unilateral vocal fold paralysis (UVFP) patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All patients diagnosed with UVFP (2008-2012) at the academic center were identified. The time from symptom onset to presentation to either community otolaryngologist and/or academic center, as well as any directed treatment(s), were recorded. Stepwise, multivariate logistic regression analysis was used to determine whether injection augmentation independently affected odds of needing definitive, framework surgery among patients who were seen within 9 months of symptom onset and had not undergone any prior rehabilitative procedures.
  
  
  RESULTS
  Cohort consisted of 633 patients (55% female, 80% Caucasian, median age 60 years) with UVFP. The majority of etiologies were either surgery (48%) or idiopathic (37%). Duration to presentation at community otolaryngologist was shorter than to the academic center (median 2 vs. 6 months). Overall, less than half of UVFP patients had any operation (46%). Multivariate logistic regression found that earlier injection augmentation did not affect odds of ultimately undergoing framework surgery (odds ratio 1.13; confidence interval, 0.92-1.40; P = 0.23).
  
  
  CONCLUSIONS
  Nearly half of UVFP patients do not require any rehabilitative procedure. When indicated, early injection augmentation is effective at temporarily alleviating associated symptoms but does not reduce likelihood of needing a definitive framework operation in patients with UVFP. Understanding practice patterns and fostering early detection and treatment may improve quality of life in this patient population.
authors.affiliation: Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.|Center for Surgical Quality and Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
authors.affiliation: Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
authors.forename: Kelly
authors.initials: K
authors.lastname: Williamson
authors.affiliation: Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
authors.forename: Kristen
authors.initials: K
authors.lastname: Hovis
authors.affiliation: Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gelbard
authors.affiliation: Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
authors.forename: Albert L
authors.initials: AL
authors.lastname: Merati
authors.affiliation: Center for Surgical Quality and Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.|Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.|Geriatric Research Education and Clinical Center, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, U.S.A.
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.affiliation: Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
authors.forename: James L
authors.initials: JL
authors.lastname: Netterville
authors.affiliation: Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.
authors.forename: C Gaelyn
authors.initials: CG
authors.lastname: Garrett
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007267:Injections; D058753:Laryngoplasty / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery*; D014833:Voice Quality
keywords: Unilateral vocal fold paralysis; framework surgery; injection augmentation; injection laryngoplasty; selection bias; time to presentation; type I laryngoplasty