Hyaluronic Acid Injection Laryngoplasty for Unilateral Vocal Fold Paralysis-A Systematic Review and Meta-Analysis

Abstract

Unilateral vocal fold paralysis (UVFP) is a common disorder that may cause glottal closure insufficiency and then hoarseness of voice and aspiration during swallowing. We conducted a systematic review and meta-analysis to evaluate whether hyaluronic acid (HA) injection laryngoplasty (IL) is an effective treatment for patients with UVFP. Comprehensive systematic searches were undertaken using PubMed, EBSCO Medline, and Cochrane Library databases. We appraised the quality of studies according to preset inclusion and exclusion criteria. The lengths of follow-up were divided into "short-term" (3 months or shorter), "medium-term" (6 months), and "long-term" (12 months or longer). We performed random-effect meta-analysis to estimate the changes in voice-related quality of life, perceptual evaluation by grading systems, voice lab analysis of maximal phonation time, and normalized glottal gap area, before and after HA IL. Fourteen studies were eligible for the final analysis. The results showed that patients' glottal closure insufficiency could be improved; maximal phonation time could be prolonged; perceptual evaluations of the voice and quality of life were better after HA IL, but the duration of treatment effect varied among different studies. In conclusion, HA IL is an effective treatment for UVFP, which may achieve a long-term effect and therefore reduce the likelihood of requiring permanent medialization thyroplasty.

Keywords: hyaluronic acid; injection laryngoplasty; meta-analysis; unilateral vocal fold paralysis.

Figure 1

Flowchart diagram of literature search and selection. Inclusion and exclusion criteria are listed in Table 1.

Figure 2

Subgroup meta-analysis of overall quality of life in short-term, medium-term, and long-term follow-up after hyaluronic acid injection laryngoplasty.

Figure 3

Subgroup meta-analysis of overall grading of different items of perceptual evaluation (G, R, B, A, S and H) in short-term, medium-term, and long-term follow-up after hyaluronic acid injection laryngoplasty.

Figure 4

Subgroup meta-analysis of overall maximal phonation time (MPT) in short-term, medium-term, and long-term follow-up after hyaluronic acid injection laryngoplasty.

Figure 5

Subgroup meta-analysis regarding overall normalized glottal gap area (NGGA) in short-term, medium-term, and long-term follow-up after hyaluronic acid injection laryngoplasty.

Figure 6

Hyaluronic acid injection laryngoplasty (arrow head) under local anesthesia, guided by flexible laryngoscopy, using the trans-cervical approach via cricothyroid membrane puncture (arrow). (a) Surgeon; (b) a patient in sitting position; (c) an assistant controls the scope.

Figure 7

Hyaluronic acid injection laryngoplasty without anesthesia, guided by laryngeal electromyography injectable needle electrode connected to electromyography machine (arrow head). The injection was also done by the trans-cervical approach via cricothyroid membrane (arrow).