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Injection Laryngoplasty for Presbylaryngis

last modified on: Tue, 02/20/2018 - 13:03

Injection Laryngoplasty for Presbylaryngis -- see video below
return to: Injection Laryngoplasty for Vocal Fold Paralysis and Glottic Incompetence
Presbyphonia defines age related voice changes. Presbylaryngis more specifically refers to the anatomic changes accompanying presbyphonia - including loss of substance associated with muscle atrophy (ref Kwon 2010).  First line therapy for presbyphonia with presbylaryngis is voice therapy, generally directing the patient to a speech pathologist with expertise in addressing vocal problems (ref Johns M 2011).  Cases refractory to voice therapy may benefit from vocal fold augmentation or medialization via injection or thyroplasty.

Gartner-Schmidt and Rosen (ref 2011) recently identified that "neither voice therapy nor surgery should be considered a certainty in helping patients with age-related vocal fold atrophy". Their efforts to quantify improvement with therapy identified that 81% diagnosed with vocal fold atrophy improved with voice therapy, but only by 48%". These investigators identified that "only 17% of the participants got better with surgery after voice therapy failed". They concluded that other comorbidities associated with advanced age may contribute the the voicing problems in a way that are not fully remediated with vocal fold augmentation or medialization.

Case Example:

Gradual decline in vocal quality ascribed to presbylaryngis. Recommendation re: voice therapy as primary management met with unproductive encounters warranting consideration for vocal fold augmentation.

2-21-2011 Transnasal fiberoptic injection laryngoplasty to left vocal cord with zyderm II yielded immediate vocal improvement but deterioration after 1 - 3 weeks. A second injection laryngoplasty 8-05-2011  done via approach below (see video) yieled immediate improvement in ease and strength of speaking persisting for one month (via phone call f/u). Subsequent f/u by phone (11-13-11) indicated that the benefit did not appear to persist beyond one month. Options discussed included thyroplasty, further consideration for voice therapy.

Click on video to activate - audio begins after 4 seconds:

References:

Kwon T-K, An S-Y, Ahn J-C, Kim K, Sung M-W: Calcium hydroxylapatite injection laryngoplasty fo rthe treatment of presbylaryngis: Long-term results.  Laryngoscope  volume 120, Issue 2 pp 326-329, Feb 2010.

Johns M, Arviso LC, Ramadan F: Challenges and opportunities in the management of the aging voice. Otolaryngol Head Neck Surg 2011;145)1):1-6

Gartner-Schmidt J and Rosen C: Treatment success for age-related vocal fold atrophy. Laryngosocpe 2011 Mar;121 (3):585-9