Case Report|Articles in Press

Local Reaction Causing Airway Compromise Following Vocal Fold Injection Augmentation with Carboxymethylcellulose



      This case report aims to identify local allergic reaction as a rare complication of vocal fold injection augmentation with carboxymethylcellulose and discuss the management of airway swelling following this reaction.


      Glottis insufficiency due to true vocal fold immobility is important to manage to reduce risk of aspiration and improve voice function. Vocal fold injection augmentation with carboxymethylcellulose is considered a safe and effective treatment for glottis insufficiency, commonly due to vocal fold immobility.


      Retrospective medical records review and case report.


      We report a unique case of an adult female with vocal fold immobility that was treated with injection laryngoplasty using carboxymethylcellulose and subsequently developed a local reaction requiring intubation and tracheostomy placement.


      Otolaryngologists should be aware of this rare, but life-threatening complication and counsel patients accordingly when obtaining consent. If there are signs and symptoms of airway edema, the patient should be transferred to the ICU for airway watch, intravenous steroids, and possible intubation.

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        • Sulica L
        • Rosen CA
        • Postma GN
        • et al.
        Current practice in injection augmentation of the vocal folds: Indications, treatment principles, techniques, and complications.
        The Laryngoscope. 2010; 120: 319-325
        • Din-Lovinescu C
        • Talmor G
        • Gravina A
        • et al.
        Adverse events following injection laryngoplasty: an analysis of the MAUDE database.
        Am J Otolaryngol. 2021; 42103092
      1. MAUDE adverse event report: CYTOPHIL, INC. RENÚ GEL, 1.5CC SYSTEM, VOCAL CORD MEDIALIZATION. Published online April 26, 2018.

      2. Maude adverse event report: merz north america, inc. Prolaryn gel injectable implant. Published online July 6, 2016.

        • Hollabaugh CB
        • Burt LH
        • Walsh AP
        Carboxymethylcellulose. Uses and applications.
        Ind Eng Chem. 1945; 37: 943-947
        • Hotta E
        • Tamagawa-Mineoka R
        • Onishi Y
        • et al.
        Immediate hypersensitivity reaction to carboxymethylcellulose in lidocaine jelly and dimethicone drops: a case report and mini-review.
        J Cutan Immunol Allergy. 2022; 5: 217-221
        • Mori S
        • Muroi N
        • Ono S
        • et al.
        Analysis of sensitization to carboxymethylcellulose: identification of high risk group using ELISA and histamine release experiment.
        Inflamm Res Off J Eur Histamine Res Soc Al. 2004; 53: 164-169
        • Ohnishi A
        • Hashimoto K
        • Ozono E
        • et al.
        Anaphylaxis to carboxymethylcellulose: add food additives to the list of elicitors.
        Pediatrics. 2019; 143e20181180
        • Brockow K
        • Bauerdorf F
        • Kugler C
        • et al.
        Idiopathic” anaphylaxis caused by carboxymethylcellulose in ice cream.
        J Allergy Clin Immunol Pract. 2021; 9: 555-557.e1
        • Elghouche AN
        • Nwosu OI
        • Jones AJ
        • et al.
        Inflammatory reactions to laryngeal injection of hyaluronic acid derivatives.
        J Voice Off J Voice Found. Published online August 6, 2022; (S0892-1997(22)00206-5)
        • Hertegård S
        • Hallén L
        • Laurent C
        • et al.
        Cross-linked hyaluronan used as augmentation substance for treatment of glottal insufficiency: safety aspects and vocal fold function.
        The Laryngoscope. 2002; 112: 2211-2219
        • Hertegård S
        • Hallén L
        • Laurent C
        • et al.
        Cross-linked hyaluronan versus collagen for injection treatment of glottal insufficiency: 2-year follow-up.
        Acta Otolaryngol (Stockh). 2004; 124: 1208-1214
        • Dominguez LM
        • Tibbetts KM
        • Simpson CB.
        Inflammatory reaction to hyaluronic acid: a newly described complication in vocal fold augmentation.
        The Laryngoscope. 2017; 127: 445-449
        • Reiter R
        • Rudolf R
        • Brosch S
        • et al.
        Laryngoplasty with hyaluronic acid in patients with unilateral vocal fold paralysis.
        J Voice Off J Voice Found. 2012; 26: 785-791
        • Verma SP
        • Dailey SH.
        Office-based injection laryngoplasty for the management of unilateral vocal fold paralysis.
        J Voice Off J Voice Found. 2014; 28: 382-386
        • Dc U
        • M J
        • Sk Z
        • et al.
        Prospective evaluation of office-based injection laryngoplasty with hyaluronic acid gel.
        Ann Otol Rhinol Laryngol. 2013; 122: 541-546
        • Friedman PM
        • Mafong EA
        • Kauvar ANB
        • et al.
        Safety data of injectable nonanimal stabilized hyaluronic acid gel for soft tissue augmentation.
        Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2002; 28: 491-494
        • Ortigosa LCM
        • Lenzoni FC
        • Suárez MV
        • et al.
        Hypersensitivity reaction to hyaluronic acid dermal filler after COVID-19 vaccination: a series of cases in São Paulo, Brazil.
        Int J Infect Dis. 2022; 116: 268-270