Voice outcomes after office-based hyaluronic acid injection for vocal fold immobility: a prospective single-center study

To assess the short-term voice quality in unilateral vocal fold paralysis (UVFP) patients after office-based hyaluronic acid injection laryngoplasty (OBIL) using the European Laryngeal Society (ELS) multidimensional voice quality assessment.

Patients with UVFP that underwent OBIL were prospectively recruited from November 2022 to November 2024, at a tertiary university medical center (laryngology unit). Voice handicap index (VHI), GRBAS perceptual evaluation, maximum phonation time (MPT), and acoustic parameters were evaluated seven days and one month post-OBIL. Videolaryngostroboscopy was evaluated to assess the glottic closure (complete or incomplete) using the ELS recommendations.

Thirty-two patients with UVFP were included. The amount of injectable ranged from 0.2 mL to 0.8 mL. Improvement in glottal closure was observed in 22/32 (75%) patients at Day-7 and 21/32 (68.8%) at one month post-OBIL. VHI significantly decreased after injection (p = 0.02). Other vocal outcomes (f0, percent jitter, percent shimmer, harmonic to noise ratio) revealed non-significant improvements (p > 0.05). MPT did not change (p = 0.37). Perceptual outcomes decreased non-significantly following OBIL, with 'breathiness' improving the most (p > 0.05).

OBIL improves voice quality in patients with UVFP. All voice quality outcomes show early improvement at Day-7 and continue to improve at Month-1 after injection. VHI emerged as the most sensitive tool for detecting voice changes.