Silk-Hyaluronic Acid Laryngoplasty Outcomes: An Independent Tertiary Center Experience

To evaluate the safety and efficacy of silk protein-hyaluronic acid (silk-HA) injection laryngoplasty for glottic insufficiency at an independent tertiary academic voice center and compare outcomes and complication rates with those of HA injection augmentation.

We retrospectively reviewed patients undergoing SilkVoice augmentation between June 2022 and August 2025 at a single institution. Outcomes included patient-reported vocal improvement, emergency department visits, hospitalizations, and operative interventions. For patients with prior HA injection, silk-HA outcomes were compared using a within-patient design.

Thirty-three patients underwent 44 silk-HA injections (mean age 73.4 years; 51.5% female). Outcome data were available for 29 patients (87.9%). Most procedures (95.5%) were office-based with a mean follow-up of 12.7 months. Overall, 86.2% of patients reported at least minimal vocal improvement and 79.3% reported partial to significant improvement. In a within-patient comparison of 20 patients who received both silk-HA and prior HA, median improvement scores were equivalent (p = 0.776). Compared with a historical HA cohort from the same institution (691 patients, 1146 injections), operative intervention was significantly higher in silk-HA (6.8% vs. 0.6%, p = 0.005); two cases were elective revisions for overaugmentation, and one occurred in the setting of lung cancer progression.

Silk-HA injection laryngoplasty demonstrates safety and efficacy for glottic insufficiency with voice outcomes comparable to HA and no increase in serious adverse events despite higher operative revision rates. These findings from an independent academic voice center provide external validation supporting silk-HA as a viable office-based augmentation option.