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Clinical Challenges
August 16, 2010

Vocal Fold Injection as a Treatment for Glottic Insufficiency: Con

Arch Otolaryngol Head Neck Surg. 2010;136(8):827-828. doi:10.1001/archoto.2010.114

Hypothesis:Injection laryngoplasty is just as good as medialization laryngoplasty (thyroplasty type I) for mild to moderate glottal insufficiency.

Although no ideal study comparing type I thyroplasty with injection laryngoplasty exists, to my knowledge, type I thyroplasty has favorable outcomes compared with injection laryngoplasty for the treatment of glottal insufficiency. While some reports1-3have commented that type I thyroplasty is better suited for larger glottal gaps than injection laryngoplasty, the study by Dursun et all3is one of the few that provides data supporting this concept. Although Dursun et al3did not make direct comparisons, type I thyroplasty had improved outcomes compared with injection laryngoplasty. Patients in the type I thyroplasty group had worse or equivalent pretreatment perceptual scores but better posttreatment perceptual evaluations. Similar findings were seen for pretreatment acoustic measures with comparable or better posttreatment acoustic measures for the type I thyroplasty group. When comparing glottal gap size, of the 14 patients who underwent injection laryngoplasty, 6 had no pretreatment gap, and at final follow-up 5 had a minimal gap and 2 had a small gap. For the 16 patients in the type I thyroplasty group, 8 had severe pretreatment gaps, 7 had moderate gaps, and 1 had a small gap, and there were 8 minimal gaps and 2 smalls gap at final follow-up.1Thus, equivalent or superior results were seen for patients in the type I thyroplasty group, which included those with more severe glottal closure problems.

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