In-Office Injection Laryngoplasty: Good Results, but Complications More Likely

Injection laryngoplasty (IL) performed in the office with the patient awake yields similar results as when it is performed with the patient asleep, researchers have found in a case-control study.

Researchers at Emory University School of Medicine in Atlanta found that both awake and asleep procedures produce about the same improvements in patients’ voices. Another key finding, however, was that there were more complications found in awake procedures than in those performed with the patient asleep, although those complications were not considered major and were self-limiting, they said.

That prompted researchers to conclude that patients who need the utmost precision-such as voice professionals-should probably have the procedure done in the operating room under general anesthesia.

In cases where you need a high level of precision, do it [with the patient] asleep, said Michael M. Johns III, MD, Director of the Emory Voice Center and Assistant Professor of Otolaryngology at Emory.

Awake and asleep injection laryngoplasty show similar effectiveness, said Clyde C. Mathison, MD, of the Department of Otolaryngology-Head and Neck Surgery at Emory, who presented the findings at the 130th Annual Meeting of the American Laryngological Association, conducted as part of the Combined Otolaryngology Spring Meeting. Awake IL does have a higher complication rate.

Injection laryngoplasty is used for the treatment of vocal fold immobility and poor glottal function due to aging and scarring. Injections are most frequently used for medialization.They have traditionally been performed in the operating room under general anesthesia using suspension microlaryngoscopy.

The procedure done while awake, using only local anesthesia, was reintroduced in the 1970s and 1980s (Dedo et al. Ann Otol Rhinol Laryngol 1973;82:661-7; Ward et al. Laryngoscope 1985;95:644-9).

The Current Study

The researchers, hypothesizing that both asleep and awake procedures would produce good results, examined all the injection laryngoplasties performed at Emory Voice Center from August 2003 to July 2008, using those with only local anesthesia as the cases and those performed with general anesthesia as the controls. The technique and the material to be used were chosen by the surgeon and the subject at the time of the consultation.

Researchers examined patients’ scores on the Voice-Related Quality of Life (VRQOL) test, as well as complication rates and types.

In this study, which was published in Laryngoscope shortly after the ALA meeting, researchers looked at 166 injections involving 141 subjects. The average age was 61 years, and 59% were male. Sixty-one percent of the patients were having the procedure done because of unilateral vocal fold immobility, and 36% because of glottal insufficiency with bilaterally mobile vocal folds.