Unilateral Vocal Fold Paralysis and Voice Therapy: Does Age Matter? A Prospective Study With 100 Consecutive Patients

Unilateral Vocal Fold Paralysis and Voice Therapy: Predictors of Long-Term Quality of Life

To date, little is known about the long-term predictors of quality of life (QoL) in unilateral vocal fold paralysis (UVFP). The main objective of this study was to evaluate the predictors of long-term QoL in UVFP patients submitted to voice therapy (VT) exclusively. Data from patients diagnosed with UVFP who followed a VT program between 2013 and 2019 were reviewed. Video laryngoscopy (VL) records were obtained at the beginning and at the end of VT. To assess QoL, Voice Handicap Index 30 (VHI-30) score was assessed in three temporal frames: before voice therapy (pre-VT), at the last VT session (post-VT), and in the present (cur-VHI). A longitudinal analysis was performed regarding the evolution of QoL and the factors influencing QoL through time were analyzed. Seventy-eight percent of patients had iatrogenic UVFP. The mean time of follow-up after VT was 3.942 years (range 6 months-7 years). There was a significant improvement in QoL through all time points (F (2,88)=72.179, p<0.001), with VHI-30 decrease from the baseline pre-VT to post-VT(p<0.001) and from post-VT to cur-VT (p=0.0013). In the iatrogenic UVFP population, patients starting VT earlier showed better long-term QoL (p=0.023). UVFP patients with dysphagia at presentation showed significantly worse QoL in the late follow-up (p=0.016). Hence, iatrogenic UVFP patients beginning VT rapidly may show better QoL in the future. Also, our results suggest that dysphagia at UVFP onset may predict higher morbidity later in life.

In vivo vocal fold augmentation using an injectable polyethylene glycol hydrogel based on click chemistry

It is important to focus on urgent needs in clinics and develop optimal materials. For successful augmentation of vocal folds, the ideal filler should be injectable through a syringe, and should stably maintain its volume for a long time without toxicity. To achieve these criteria, a click chemistry-based PEG (polyethylene glycol) hydrogel was developed and applied for vocal fold augmentation in vivo. The PEG hydrogel enables fast gelation in vivo after injection and provides long-term stability. Azide- and dibenzocyclooctyne (DBCO)-modified 4-arm PEG were cross-linked by chemical conjugation via click chemistry and yielded gelation within several minutes. After subcutaneous injection into mice and rats, the PEG hydrogel showed higher stability after 1 month compared to the traditionally used calcium hydroxyapatite-carboxymethyl cellulose (CaHA-CMC) filler. In rabbit models with vocal fold paralysis, the PEG hydrogel stably fixed the paralyzed vocal fold in 4 months and minimized the glottic gap. It was an improved therapeutic result compared to CaHA-CMC, demonstrating the potential of a click chemistry-based PEG hydrogel for vocal fold therapy.

Presbylarynx: Does Body Muscle Mass Correlate With Vocal Atrophy? A Prospective Case Control Study

OBJECTIVE

To analyze the potential association between body muscle mass and presbylarynx.

METHODS

Study performed on subjects referred to the otorhinolaryngology department in a tertiary center between January and September 2019 . Based on endoscopic findings of the larynx, the patients were subdivided into two main groups: presbylarynx versus no presbylarynx. Data regarding gender, body composition, self-assessment of vocal complaints, and functional assessment were collected.

STUDY DESIGN

Case control, prospective, observational and cross-sectional.

RESULTS

The study population included a total of 115 Caucasian subjects (43 males; 72 females). Presbylarynx was identified in 43 patients (37, 39%) with no statistically predilection by gender (P = .668). The mean age of the patients with presbylarynx was slightly higher, but differences between groups were not statistically significant (P = .072). Results showed an association between functional impairment (score 4 of Katz Index and score 5 of Functional Ambulation Classification) and presence of presbylarynx (P < .001). Additionally, a positive association between the absence of presbylarynx and sport activity was also observed (P < .001). The mean value of muscle mass between presbylarynx and no presbylarynx groups was statistically different (P < .01), with a lower mean for subjects with presbylarynx.

CONCLUSION

This case control prospective study confirms that the general age-related degeneration of body muscle mass might play an important role in the course of presbylarynx. In the future, preventing strategies based on regular sport activities and improvements on functional status can play an important role in the management of aging voice.

LEVEL OF EVIDENCE

2b Laryngoscope, 131:E226-E230, 2021.