Treatment Durability of Injection Augmentation of Vocal Fold Atrophy

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-08-06 DOI:10.1002/lio2.70223

Anumitha Venkatraman, Ruth J. Davis, Susan Thibeault

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Abstract

Objective

Injection augmentation (or injection laryngoplasty) is a common treatment for presbyphonia. As current injection materials are temporary, it is anticipated that patients injected for presbyphonia will either need a repeat injection or framework surgery to maintain glottal competence (or sufficient glottal closure). Despite the expected temporary nature of these injections, patients report variable durability of effect, and some do not require a repeat injection. The primary aim of this investigation was to identify factors that affect treatment durability of injection augmentation among patients with presbyphonia.

Methods

Patients who underwent one or multiple injection augmentations for presbyphonia between May 2008 and September 2017 were extracted from the UW Madison Voice and Swallow Outcomes Database. Variables collected included demographics (age, sex), injection material, volume, duration between injections, date of first and last follow-up, voice therapy (yes/no, number of sessions), and pre- and post-injection voice measures (Maximum Phonation Time, Dysphonia Severity Index, Glottal Function Index score, Vocal Handicap Index Score) in an observational cohort design. For patients receiving one injection (TF group), duration between injection and last follow-up was taken as a durability measure termed “time to follow up.” For patients receiving multiple injections (TR group), duration between injection treatments were termed “time to reinjection.” Patients receiving one or more injections were compared separately and together (where treatment durability_TF+TR refers to the combined TF + TR group) in different statistical analyses.

Results

Thirty-five patients with presbyphonia met inclusion criteria (mean age 74.3 years [SD 7.6], 78% male). Twenty patients received only one injection. Repeat injection augmentation was performed in 40% of patients (n = 15, ranging from 1 to 6 additional injection augmentations). Maximum phonation time increased after injection augmentation (or injection laryngoplasty) and was similar across injection materials (HA (mean change (SD)): +6 s (3) [95% CI 0.1–0.8], CaHa: +4 s (2.8) [95% CI 0.2–0.7], p < 0.001). Treatment durability_TF+TR was longer for hyaluronic acid injectables when compared to calcium hydroxyapatite injectables (1232 days [CI: 552–1911] vs. 257 days [168–345], χ²(2) = 7.505, p = 0.023). Voice therapy extended treatment durability TF_+TR for injection augmentation compared to no voice therapy (1388 [95% CI: 772–2003] vs. 277 days [206–349 days], χ²(1) = 9.173, p = 0.002). Age did not affect treatment durability TF_+TR (χ²(1) = 1.01, p = 0.67).

Conclusion

Factors that affected treatment durability TF_+TR for injection augmentation treatments were the type of injectable and whether patients underwent adjuvant voice therapy.

Level of Evidence

III, Retrospective cohort study.

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声带萎缩注射增强术的治疗持久性

目的注射隆喉术（或注射喉成形术）是治疗老年性耳鸣的常用方法。由于目前的注射材料是暂时的，预计因耳鸣而注射的患者将需要重复注射或框架手术来维持声门功能（或充分关闭声门）。尽管预期这些注射具有暂时性，但患者报告的效果持久性各不相同，有些患者不需要重复注射。本研究的主要目的是确定影响老年性耳鸣患者注射增强治疗持久性的因素。方法从威斯康星大学麦迪逊分校的Voice and Swallow Outcomes数据库中提取2008年5月至2017年9月期间接受过一次或多次注射增强治疗的老年性耳聋患者。在观察性队列设计中，收集的变量包括人口统计学（年龄、性别）、注射材料、体积、注射间隔时间、首次和最后一次随访日期、语音治疗（是/否、疗程数）、注射前后语音测量（最大发声时间、发音障碍严重指数、声门功能指数评分、声带障碍指数评分）。对于接受一次注射的患者（TF组），注射和最后一次随访之间的时间作为一种持久性测量，称为“随访时间”。对于接受多次注射的患者（TR组），两次注射之间的时间称为“再注射时间”。在不同的统计分析中，分别比较接受一次或多次注射的患者和一起进行比较（其中治疗持久性TF+TR指TF+TR联合组）。结果35例患者符合纳入标准（平均年龄74.3岁[SD 7.6]， 78%为男性）。20例患者仅接受一次注射。40%的患者（n = 15）进行了重复注射增强，范围从1到6次额外注射增强)。注射增强（或注射喉部成形术）后最大发声时间增加，不同注射材料的最大发声时间相似(HA（平均变化（SD））： +6 s （3) [95% CI 0.1-0.8], CaHa: +4 s (2.8) [95% CI 0.2-0.7], p < 0.001）。与羟基磷灰石钙注射剂相比，透明质酸注射剂的tf +TR治疗持续时间更长（1232天[CI: 552-1911]比257天[168-345]，χ2(2) = 7.505, p = 0.023）。与无语音治疗相比，语音治疗延长了注射增强TF+TR的治疗持久性（1388 [95% CI: 772-2003]比277[206-349]天，χ2(1) = 9.173, p = 0.002）。年龄对治疗持久性TF+TR无影响（χ2(1) = 1.01, p = 0.67）。结论影响注射增强TF+TR治疗持久性的因素有注射类型和患者是否接受了辅助语音治疗。证据水平III，回顾性队列研究。

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