Time to Injection Laryngoplasty: A Quality Improvement Analysis

Vocal fold (VF) augmentation injection laryngoplasty with hyaluronic acid is an effective and rapid office-based treatment for glottic insufficiency. Early injection laryngoplasty, defined as augmentation within the first three months, can decrease the risk of hospital readmission, aspiration pneumonia, and potentially reduce the need for future permanent surgical procedures such as Type 1 thyroplasty. This study aims to identify the time to injection for first-time laryngoplasty, describe the demographics of patients requiring VF medialization, and investigate causes for delays in treatment.

This quality improvement assessment evaluated the time to first injection in patients requiring VF augmentation at the Voice and Dysphagia Laboratory at McGill University. This was a retrospective analysis of patients who received their initial hyaluronic acid injection for glottic insufficiency between April 2021 and March 2024. Patient demographics and reasons for delays were extracted from clinical records (ie, antithrombotic therapy, voice therapy attempts, anxiety, immunosuppressant medications, laryngeal infections, and cases of non-urgent or longstanding paralysis).

One hundred thirty-nine patients underwent VF augmentation. 48.9% were female and 51.1% male, with an average age of 66.2 years. The majority were treated for vocal cord paralysis (71.9%), followed by VF atrophy/presbylarynx (22.3%) and scarring (2.2%). Causes of paralysis included iatrogenic (49%), idiopathic (30%), neoplastic (18%), and others (3%). The mean time to injection for all patients was 21.7 days. Patients with glottic insufficiency causing aspiration or dysphagia were injected within 9.8 days (n = 56; VF paralysis n = 49, VF atrophy n = 7). Those with VF paralysis were injected within 13.5 days of initial consultation (n = 100) and those with VF paralysis and aspiration or dysphagia were injected within 10.1 days (n = 48). Patients with VF paralysis without delaying factors were augmented with injection in 1.44 days (n = 106). Thirty-three patients had delays in receiving their injection laryngoplasty and were injected at a mean of 80.0 days. Patients with delaying factors with aspiration or dysphagia were injected within 34.9 days (n = 16).

Our institution successfully achieves early injection in the majority of patients, with injections administered within two days of diagnosis when no "delaying factors" are present. Our main delaying factor was antithrombotic therapy use.