Early-injection laryngoplasty may lower risk of thyroplasty: A systematic review and meta-analysis

Abstract

Objective: To determine whether injection laryngoplasty within 6 months following the onset of unilateral vocal fold paralysis (UVFP) decreases the rate of permanent thyroplasty in adults.

Data sources: Search strategies created by a medical librarian were implemented in multiple online research databases.

Review methods: Inclusion and exclusion criteria were designed to capture randomized clinical trials and cohort studies examining adults with UVFP who received injection laryngoplasty early in the course of treatment, within 6 months of onset, or who were observed. The primary outcome was the rate of thyroplasty. The Newcastle-Ottawa scale was used to assess quality of included cohort studies. Random effects meta-analysis was used to calculate an overall relative risk (RR). Heterogeneity was evaluated with the I² statistic.

Results: The search strategy resulted in 1,177 studies, of which four cohort studies remained for meta-analysis after applying inclusion and exclusion criteria. All studies were rated as 9 of 9 on the Newcastle-Ottawa scale. Meta-analysis of 275 patients with UVFP revealed that the overall pooled RR of undergoing thyroplasty in those receiving an early injection was 0.25 (95% confidence interval 0.14-0.45) compared to conservative management (late or no injection). The I² overall was 62.4%.

Conclusion: Otolaryngologists should offer injection laryngoplasty to patients with a diagnosis of UVFP within 6 months of diagnosis (recommendation based on grade C evidence with a preponderance of benefit over harm). Laryngoscope, 128:935-940, 2018.

Keywords: Paralysis; adult; laryngoplasty; meta-analysis; treatment outcome; unilateral; vocal cord; vocal fold.