Summary
Objectives
Silk-Hyaluronic Acid (Silk-HA) is a novel vocal fold augmentation material that has
been used in humans since July 2020. There is a paucity of published data on Silk-HA
and its longevity remains a question. This study aimed to evaluate a single surgeon's
initial experience performing Silk-HA injection laryngoplasty for the treatment of
glottic insufficiency.
Methods
Retrospective chart review of Silk-HA injections between July 2020 and December 2021.
Subject demographics, diagnoses, volume of material injected, VHI-10 data, and complications
were collected. A blinded perceptual voice analysis of voice samples was performed
by two voice-specialized speech-language pathologists (SLP) for a subset of unilateral
vocal fold paralysis patients before and 3-months following silk-HA injection. Univariate
assessment of the change in VHI-10 and perceptual voice analyses at 3-month follow
up was determined.
Results
58 patients (43.1% female) underwent Silk-HA injection with a mean age of 64 (range
21-88). 38 subjects had unilateral paralysis (65.6%), and the remaining had scar,
atrophy, paresis or a combination thereof. 49 injections were unilateral (84.5%).
Mean volume of silk injected was 0.26 mL. Complications were rare, most notable though
for 2 admissions for dyspnea and laryngoscopic evidence of hemi-laryngeal edema (3.4%).
Mean change in CAPE-V overall severity rating was -32.9 (P<0.0001), and VHI-10 was -14.6 ± 10 (P=0.0013). 14 patients underwent a repeat silk-HA injection for ongoing glottic insufficiency
(loss of augmentation vs under-augmentation).
Conclusions
Preliminary results for Silk-HA show potential for ongoing improvement of glottic
insufficiency at 3 months from date of augmentation. Clinician and patient perception
of voice outcomes showed overall improvement at three months, though longevity remains
to be determined. While overall well tolerated and without serious complications in
96% of the cohort, patients should be counseled on the potential for airway edema
and symptomatic dyspnea requiring steroid management and observation.
Key Words
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References
- Operating room versus office-based injection laryngoplasty: a comparative analysis of reimbursement.Laryngoscope. 2007; 117: 226-230https://doi.org/10.1097/01.mlg.0000250898.82268.39
- Current practice in injection augmentation of the vocal folds: indications, treatment principles, techniques, and complications.Laryngoscope. 2010; 120: 319-325https://doi.org/10.1002/lary.20737
- Comparison of outcomes and complications between awake and asleep injection laryngoplasty: a case-control study.Laryngoscope. 2009; 119: 1417-1423https://doi.org/10.1002/lary.20485
- Uber eine neue Behandlungsmethode der Rekurrenslahmung.Verh Dtsch Laryng. 1911; 18: 93-151
- Difficulties in endoscopic removal of Teflon granulomas of the vocal fold.Ann Otol Rhinol Laryngol. 1993; 102: 405-412https://doi.org/10.1177/000348949310200601
- Teflon granulomas and overinjection of Teflon: a therapeutic challenge for the otorhinolaryngologist.Ann Otol Rhinol Laryngol. 1993; 102: 748-751https://doi.org/10.1177/000348949310201002
- Teflon vocal fold augmentation: failures and management in 28 cases.Otolaryngol Head Neck Surg. 1993; 109: 493-498https://doi.org/10.1177/019459989310900318
- Vocal fold augmentation with calcium hydroxylapatite.Otolaryngol Head Neck Surg. 2004; 131: 351-354https://doi.org/10.1016/j.otohns.2004.03.025
- Long-term results of calcium hydroxylapatite for vocal fold augmentation.Laryngoscope. 2011; 121: 313-319https://doi.org/10.1002/lary.21258
- Vocal fold augmentation with calcium hydroxylapatite: twelve-month report.Laryngoscope. 2009; 119: 1033-1041https://doi.org/10.1002/lary.20126
- Vocal fold injection: review of indications, techniques, and materials for augmentation.Clin Exp Otorhinolaryngol. 2010; 3: 177-182https://doi.org/10.3342/ceo.2010.3.4.177
- Advances in office-based diagnosis and treatment in laryngology.Laryngoscope. 2009; 119: S185-S212https://doi.org/10.1002/lary.20712
- A novel silk-based vocal fold augmentation material: 6-month evaluation in a canine model.Laryngoscope. 2019; 129: 1856-1862https://doi.org/10.1002/lary.27618
- Injectable silk protein microparticle-based fillers: a novel material for potential use in glottic insufficiency.J Voice. 2019; 33: 773-780https://doi.org/10.1016/j.jvoice.2018.01.017
- Development and validation of the voice handicap index-10.Laryngoscope. 2004; 114: 1549-1556https://doi.org/10.1097/00005537-200409000-00009
- Preliminary results of a new temporary vocal fold injection material.J Voice. 2005; 19: 668-673https://doi.org/10.1016/j.jvoice.2005.01.009
- Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders.J Voice. 2007; 21: 576-590https://doi.org/10.1016/j.jvoice.2006.05.001
- Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.Am J Speech Lang Pathol. 2009; 18: 124-132https://doi.org/10.1044/1058-0360(2008/08-0017
- Application of psychometric theory to the measurement of voice quality using rating scales.J Speech Lang Hear Res. 2005; 48: 323-335https://doi.org/10.1044/1092-4388(2005/022
- Minimal clinically important difference of voice handicap index-10 in vocal fold paralysis.Laryngoscope. 2018; 128: 1419-1424https://doi.org/10.1002/lary.27001
- In vivo characterization of the integration and vascularization of a silk-derived surgical scaffold.J Plast Reconstr Aesthet Surg. 2016; 69: 1141-1150https://doi.org/10.1016/j.bjps.2016.01.017
- Materials fabrication from Bombyx mori silk fibroin.Nat Protoc. 2011; 6: 1612-1631https://doi.org/10.1038/nprot.2011.379
- Sustained volume retention in vivo with adipocyte and lipoaspirate seeded silk scaffolds.Biomaterials. 2013; 34: 2960-2968https://doi.org/10.1016/j.biomaterials.2013.01.058
- Inflammatory reaction to hyaluronic acid: a newly described complication in vocal fold augmentation.Laryngoscope. 2017; 127: 445-449https://doi.org/10.1002/lary.26156
- Patient tolerance of awake, in-office laryngeal procedures: a multi-institutional perspective.Laryngoscope. 2012; 122: 315-321https://doi.org/10.1002/lary.22185
- Frame by frame analysis of glottic insufficiency using laryngovideostroboscopy.J Voice. 2012; 26: 220-225https://doi.org/10.1016/j.jvoice.2011.01.008
Article info
Publication history
Published online: December 16, 2022
Accepted:
November 7,
2022
Publication stage
In Press Corrected ProofFootnotes
Funding: None
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
