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Otolaryngologists Vary Significantly in Choice of Injectable Materials for Vocal Fold Injection Augmentation

by Linda Kossoff •

What are the variations in provider preference and utilization of injectable materials for vocal fold injection (VFI) augmentation?

BOTTOM LINE

There are significant variations in preferences regarding VFI materials, although hyaluronic acid (HA)-based products are the most frequently used by providers.

BACKGROUND: VFI is an effective treatment for glottic insufficiency. Advances in injection material availability have helped expand VFI use, while rapid changes in available material options have increased the variability of provider preferences. The materials differ in their duration of effect, and decisions regarding their selection are not standardized.

STUDY DESIGN: Survey research.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.

SYNOPSIS: Researchers designed an electronic survey of 40 questions pertaining to the preferences and practices of American laryngologists in terms of vocal fold injectables. Of the 158 laryngologists contacted, 97 (61.4%) participated in the survey. Most respondents were fellowship trained (92.8%) and practiced in an academic setting (93.8%), with clinical experience in the field ranging from < five years to > 15 years. Responses showed that the most frequently used injectable materials were HA-based products, used for acute/ subacute vocal fold paralysis, presbyphonia, and sulcus/scar (54.2%, 61.5%, 44.7%, and 41.7%, respectively). However, 17.8% of participants discontinued HA-based products, largely due to adverse effects. Carboxymethycellulose- based products were preferred for trial augmentation (57.2%); 21.8% of participants discontinued these products due to quick material resorption. Calcium hydroxyapatite-based products were preferred for long-term paralysis; 26% of respondents abandoned these products, mostly due to inflammatory properties. More than 30% of respondents reported wanting to reinitiate micronized alloderm Cymetra as an available injectable. Brand choice seemed largely driven by situational factors like availability and cost. The study was limited by its recruiting metholodogy, survey response rate, and descriptive response nature.

CITATION: Kharidia KM, Bensoussan Y, Rosen CA, et al. Variations in practices and preferences of vocal fold injection materials: A national survey. Laryngoscope. 2023;133:1176–1183.