Time to Injection Laryngoplasty: A Quality Improvement Analysis

Area of Science:

• Otolaryngology
• Speech and Hearing Science
• Medical Technology

Background:

• Vocal fold (VF) augmentation injection laryngoplasty using hyaluronic acid offers rapid, office-based treatment for glottic insufficiency.
• Early intervention (within 3 months) can prevent hospital readmissions, aspiration pneumonia, and reduce the need for permanent surgical procedures like Type 1 thyroplasty.

Purpose of the Study:

• To determine the average time to first injection laryngoplasty for glottic insufficiency.
• To characterize patient demographics undergoing VF medialization.
• To identify factors causing treatment delays.

Main Methods:

• A retrospective quality improvement assessment analyzed patients receiving initial hyaluronic acid injection for glottic insufficiency between April 2021 and March 2024.
• Data on patient demographics and reasons for delay (e.g., antithrombotic therapy, voice therapy, anxiety, infections) were extracted from clinical records.

Main Results:

• 139 patients underwent VF augmentation; 48.9% female, 51.1% male, average age 66.2 years.
• Vocal cord paralysis (71.9%) was the most common indication, followed by VF atrophy (22.3%).
• Mean time to injection was 21.7 days; patients with aspiration/dysphagia were injected within 9.8 days. Patients without delaying factors received injections within 1.44 days.

Conclusions:

• The institution achieves early injection laryngoplasty in most patients, often within two days when no delaying factors are present.
• Antithrombotic therapy was identified as the primary factor delaying treatment.
• Prompt injection is crucial for managing glottic insufficiency and associated complications.