Diagnostic Vocal Fold Augmentation in Patients With Both Age-related Vocal Fold Atrophy and Parkinson's Disease

It remains controversial as to whether or not improving glottic insufficiency contributes to voice handicap improvement in patients with Parkinson's disease (PD). In addition, the existing literature is sparse and not always objective in its primary outcome measures. This case series' objective is to add to the existing literature by evaluating Voice Handicap Index-10 (VHI) changes in patients with both age-related true vocal fold atrophy and PD who underwent vocal fold injection augmentation with a temporary material.

Retrospective chart review of patients with PD who underwent temporary injection augmentation for a dominant diagnosis of age-related true vocal fold atrophy from 2019 to 2024. The VHI was used to assess voice-related handicap preprocedure and postprocedure. In addition, patients' self-impression of improvement after the procedure and number of subjects who progressed to permanent augmentation procedure were recorded. Patients with incomplete VHI data were excluded.

Seventeen patients (age 68.4 ± 7.2) met the inclusion criteria, with all showing preinjection glottic insufficiency and an average VHI score of 26.1 ± 6.8. Carboxymethylcellulose was used in 15 patients and hyaluronic acid in two. Fourteen of the 17 patients (82.35%) reported subjective improvement (P value: 0.03); 10 (58.82%) patients had improvement in VHI-10 score after temporary injection. Eight (47%) patients underwent durable injection augmentation (fat and silk-hyaluronic acid) or medialization laryngoplasty after the trial augmentation.

PD patients with glottic insufficiency due to age-related true vocal fold atrophy appear to benefit both subjectively and objectively from temporary injection augmentation. Further studies evaluating permanent augmentation outcomes are needed.