Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
J Voice. 2020 May;34(3):471-476. doi: 10.1016/j.jvoice.2018.11.004. Epub 2018 Nov 30.
Vocal fold injection augmentation (VFIA) is employed diagnostically for patients with subtle glottic insufficiency. Its use in patients with both vocal fold atrophy and benign essential voice tremor (EVT) has been reported but not after durable augmentation. This study intends to evaluate the success of durable VFIA using either autologous fat or calcium hydroxylapatite in patients with both vocal fold atrophy and comorbid EVT.
METHODS/DESIGN: Retrospective review. Subjects included demonstrated subtle glottic insufficiency from true vocal fold atrophy and comorbid EVT with no other vocal fold pathology. Voice Handicap Index (VHI-10), aerodynamic data including subglottic pressure and airflow, and the tremor scoring scale were evaluated before diagnostic VFIA with carboxymethylcellulose and after durable VFIA with calcium hydroxylapatite or autologous fat.
Seven patients met inclusion criteria. Six subjects went on to durable VFIA. Three of six demonstrated meaningful improvement in the VHI-10 score. Subglottic pressure improved significantly in those subjects with meaningful VHI-10 improvement compared to those that did not. The tremor did not resolve completely in any subject, but patient satisfaction and function was improved in four of the six.
VFIA for EVT in the setting of true vocal fold atrophy appears to offer benefit and may be an alternative treatment pathway for EVT patients. More than half of the subjects who underwent durable VFIA after successful diagnostic VFIA reported improvement in their communication despite inconsistent objective outcomes. Subglottic pressure improved significantly in half of the subjects who also reported a substantive improvement in their VHI-10.
声带注射增强术（VFIA）用于诊断细微的声门不全患者。已经有报道称，它可用于声带萎缩和良性特发性声带震颤（EVT）患者，但不能用于持久增强。本研究旨在评估使用自体脂肪或羟基磷灰石进行持久 VFIA 在同时患有声带萎缩和合并 EVT 的患者中的效果。
方法/设计：回顾性研究。纳入的受试者为因真性声带萎缩和合并 EVT 而出现细微声门不全，且无其他声带病变的患者。在使用羧甲基纤维素进行诊断性 VFIA 之前和使用羟基磷灰石或自体脂肪进行持久 VFIA 之后，评估了嗓音障碍指数（VHI-10）、包括声门下压和气流在内的空气动力学数据以及震颤评分量表。
7 名患者符合纳入标准。6 名患者接受了持久的 VFIA。6 名患者中有 3 名在 VHI-10 评分上有明显改善。与 VHI-10 改善不明显的患者相比，那些 VHI-10 有明显改善的患者声门下压明显改善。没有患者的震颤完全缓解，但 6 名患者中有 4 名的患者满意度和功能得到了改善。
在真性声带萎缩的情况下，针对 EVT 的 VFIA 似乎有益，可能是 EVT 患者的另一种治疗途径。在成功进行诊断性 VFIA 后接受持久 VFIA 的患者中，超过一半的患者尽管客观结果不一致，但仍报告他们的沟通能力有所改善。在一半报告 VHI-10 有实质性改善的患者中，声门下压明显改善。
