Evaluation and Management of Inflammatory Reactions to Vocal Fold Injection Laryngoplasty with Hyaluronic Acid

Dylan J Cooper; Seth E Kaplan

doi:10.1016/j.jvoice.2023.07.031

Evaluation and Management of Inflammatory Reactions to Vocal Fold Injection Laryngoplasty with Hyaluronic Acid

J Voice. 2023 Sep 1:S0892-1997(23)00238-2. doi: 10.1016/j.jvoice.2023.07.031. Online ahead of print.

Authors

Dylan J Cooper¹, Seth E Kaplan²

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Northwell Health - Lenox Hill, New York, New York. Electronic address: dcooper12@northwell.edu.
² Department of Otolaryngology - Head and Neck Surgery, Northwell Health - Lenox Hill, New York, New York.

PMID: 37661521
DOI: 10.1016/j.jvoice.2023.07.031

Abstract

Objectives: Inflammatory reaction to vocal fold injection laryngoplasty with hyaluronic acid (HA) is a rare condition whose optimal management is not established. In this study, we aim to review the presentation of these reactions and outline an approach for evaluation and management.

Methods: We performed a retrospective review of all patients at our institution who underwent vocal fold injection augmentation with HA during the period extending from August 2018 until October 2022. We then identified patients with postinjection inflammatory reaction and reviewed demographic data, indication for injection, amount of HA injected, setting of procedure, and symptoms. The types of complication, management plan, onset, and time to complete resolution were also recorded. A comprehensive literature search for similar complications was conducted for comparative analysis. Once the available data were aggregated with our institutional experience, we developed an algorithmic approach to manage this condition.

Results: We identified 83 patients (124 vocal folds) who underwent vocal fold injection laryngoplasty with HA over a 4-year period. Four patients (4.8%) had a postprocedure inflammatory reaction (5.6% of all vocal folds). Of the four patients, three presented with dyspnea and stridor, while one presented with dysphonia, with onset of symptoms ranging from 24 to 48 hour postinjection. All patients were treated with corticosteroids. For comparative analysis, we identified 24 patients from the literature with reported inflammatory reactions to HA.

Conclusion: We suggest an algorithmic approach to managing laryngeal inflammation following HA injection. Familiarity with treatment for this rare complication is essential to avoid significant morbidity and achieve optimal outcomes.

Keywords: Glottic insufficiency; Hyaluronic acid; Inflammatory reaction; Injection laryngoplasty; Vocal fold augmentation.