Timing of Intracordal Trafermin Injection in Patients With Vocal Fold Paralysis: Recommendations for a New Treatment Time Course.

Abstract

Objective: To identify factors correlated with the effect of intracordal trafermin injection.

Study design: Retrospective cohort study.

Methods: Herein, 177 patients who received an intracordal trafermin injection at the Tokyo Voice Center for vocal fold paralysis were included. Medical records of patients were retrospectively reviewed. Information regarding age, sex, date of trafermin injection, date of vocal fold paralysis onset, and voice data indices [maximum phonation time (MPT), pitch range (PR), mean flow rate (MFR), and Voice Handicap Index (VHI)] was extracted. The primary endpoint was the rate of improvement in the VHI, defined as the difference in the VHI values before and after the injection.

Results: A total of 80 patients (49 men and 31 women; mean age, 61.6 years) were included. No correlations existed between the MPT (r = 0.05, P = 0.64), PR (r = 0.03, P = 0.77), or MFR (r = -0.09, P = 0.42) before injection and the rate of improvement in the VHI. Analyses of 74 cases with an interval of <1000 days between disease onset and injection revealed no correlation between the number of days from the onset to injection and the rate of improvement in the VHI. In 17 cases with an interval of <90 days, a moderate negative correlation existed between these parameters (r = -0.59, P < 0.01). In a univariate linear regression analysis, within 90 days, a 1-week delay in trafermin injection resulted in a 4.87 decrease in the VHI.

Conclusions: Intracordal trafermin injection may be an effective therapeutic strategy for severe vocal fold paralysis, with a particularly high efficacy when performed early after paralysis onset. In patients undergoing aortic surgery, intracordal trafermin injection post surgery and before extubation may prevent or reduce postoperative voice disorders caused by vocal fold paralysis due to recurrent nerve palsy and prevent postoperative pulmonary complications.