Results of transoral injection laryngoplasty in the apneic window

The aim of this study was report the feasibility, safety profile, and within-patient voice outcomes of transoral injection laryngoplasty performed during a protocolized apneic window in unilateral vocal fold paralysis (UVFP).

This retrospective single-arm cohort study included patients who underwent transoral IL in the apneic window because of UVFP between February 2021 and March 2024. The following parameters were compared before and after the injection: GRBAS, maximum phonation time (MPT,seconds), Turkish Voice Handicap Index-10 (T-VHI-10), Turkish Voice-Related Quality of Life Questionnaire (T-V-RQOL), Turkish Eating Assessment Tool (T-EAT-10), and acoustic analysis parameters (F0, Jitter (%), Shimmer (%), CPPs, AVQI v03.01).

Final analysis was made of 27 patients, comprising 19 (70.4 %) females and 8 (29.6 %) males, with a mean age of 58 years (range, 21-75 years). Following the apneic window IL technique, statistically significant decreases were determined in the GRBAS G-score (2.36 vs.0.28, p< 0.001), MPT (5.68 vs.13.56 secs, p< 0.001), T-VHI-10 (28 vs. 6, p<0.001), and T-EAT-10 (14 vs. 4, p<0.001). In the acoustic voice analysis, statistically significant decreases were observed in Jitter % (0.67 vs. 0.3, p< 0.001), Shimmer % (5.81 vs.1.6, p< 0.001) and AVQI v03.01 (5.9 vs. 2.8, p< 0.001).

Transoral IL in an apneic window is a feasible and safe tubeless option that yielded significant within-patient improvements across perceptual, aerodynamic, patient-reported, and acoustic domains under a predefined safety workflow. The technique preserves a wide, tube-free operative field and may be considered complementary in selected candidates. Comparative studies versus intubated IL are warranted to establish non-inferiority or superiority.