title: Functional assessment of glottal insufficiency treated by hyaluronic acid injection: Retrospective 20-case series.
abstract: OBJECTIVE
  The objectives of the present study were to describe hyaluronic acid injection to the vocal folds as treatment for glottal insufficiency, assess indications and report vocal results at 1 month and later than 6 months postoperatively.
  
  
  METHODS
  A single-center retrospective study was performed for the period March 2012 to August 2015. Inclusion criteria comprised: unilateral recurrent nerve palsy or vocal fold closure defect with conserved mobility. Exclusion criteria comprised: previous thyroplasty, severe swallowing disorder, and cognitive disorder hindering subjective vocal assessment. Restylane®injection was performed under general or local anesthesia. The Vocal Handicap Index (VHI), maximum phonation time (MPT) and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) score were assessed preoperatively and at 1 month and more than 6 months postoperatively.
  
  
  RESULTS
  Twenty patients were included: 14 with unilateral recurrent nerve palsy and 6 with vocal fold closure defect. Restylane®injection was performed under general anesthesia in 16 patients and local anesthesia in 4 (20%). At 1-month assessment, there was significant reduction in VHI (by 36 points; P=0.0001) and GRBAS score (by 6.95 points; P=0.0001) and significant increase in MPT (by 4.95sec; P=0.0001). At 6 months, VHI, MPT and GRBAS scores remained significantly improved (respectively, P=0.0002, P=0.001 and P=0.0001), without significant difference from 1-month levels. Three patients had minor complications; two recovered normal vocal fold mobility.
  
  
  CONCLUSIONS
  Hyaluronic acid injection was effective in treating glottal failure, improving objective and subjective vocal parameters, which remained satisfactory even 6 months postoperatively.
authors.affiliation: Service d'ORL CHU Bretonneau, Université François-Rabelais Tours, 2, boulevard Tonnellé, 37000 Tours, France.
authors.forename: C
authors.initials: C
authors.lastname: Dorbeau
authors.affiliation: Service d'ORL CHU Bretonneau, Université François-Rabelais Tours, 2, boulevard Tonnellé, 37000 Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Marmouset
authors.affiliation: Service d'ORL CHU Bretonneau, Université François-Rabelais Tours, 2, boulevard Tonnellé, 37000 Tours, France.
authors.forename: E
authors.initials: E
authors.lastname: Lescanne
authors.affiliation: Service d'ORL CHU Bretonneau, Université François-Rabelais Tours, 2, boulevard Tonnellé, 37000 Tours, France.
authors.forename: D
authors.initials: D
authors.lastname: Bakhos
authors.affiliation: Service d'ORL CHU Bretonneau, Université François-Rabelais Tours, 2, boulevard Tonnellé, 37000 Tours, France. Electronic address: moriniere@univ-tours.fr.
authors.forename: S
authors.initials: S
authors.lastname: Morinière
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055154:Dysphonia / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D015552:Injections, Intralesional / Q000379:methods; D008297:Male; D008875:Middle Aged; D061226:Recurrent Laryngeal Nerve Injuries / Q000150:complications* / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage*; D014826:Vocal Cord Paralysis / Q000150:complications* / Q000188:drug therapy*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: Dysphonia; Hyaluronic acid; Laryngeal palsy; Larynx; Vocal folds; Voice