Bergeron Mathieu, Giliberto John Paul, Tabangin Meredith E, de Alarcon Alessandro
Department of Pediatric Otolaryngology, CHU Sainte-Justine, Montreal, QC, Canada.
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA.
Ann Otol Rhinol Laryngol. 2022 Feb;131(2):134-139. doi: 10.1177/00034894211012594. Epub 2021 May 5.
Post airway reconstruction dysphonia (PARD) is common and has a significant effect on the quality of life of patients. Vocal fold injection augmentation (VFIA) is one treatment that can be used to improve glottic insufficiency in some patients. The goal of this study was to characterize the use and outcomes of VFIA for PARD.
Retrospective chart review from January 2007 to July 2018 at a tertiary pediatric care center. Consecutive patients with PARD who underwent VFIA, who had a preoperative voice evaluation and a follow-up evaluation within 3 months after VFIA (fat, carboxymethylcellulose gel, hyaluronic acid).
Thirty-four patients (20 female) underwent VFIA. The mean age at the time of the injection was 13.6 years (SD 6.1). Twenty patients (58.8%) had a history of prematurity and a mean of 1.8 open airway surgeries. After injection, 29/34 patients (85.3%) noted a subjective voice improvement. The baseline Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) overall severity score decreased by a mean of 5.7 (SD = 19.6) points, = .12. Total pediatric Voice Handicap Index (pVHI) improved by 6.0 (SD = 19.5) points, from 57.4 (SD = 20.0) to 51.4 (SD = 17.2), = .09. Functional pVHI subscore demonstrated a significant improvement, with a decrease of 3.4 (SD = 7.3) points, = .02. All procedures were performed as an overnight observation and no complication occurred.
Patients with PARD represent a complex subset of patients. VFIA is a straightforward intervention that may improve voice perception. Many patients reported subjective improvement despite minimal objective measurement. Further work is warranted to elucidate the role of injection in management of PARD.
气道重建后发声障碍（PARD）很常见，对患者的生活质量有重大影响。声带注射填充术（VFIA）是一种可用于改善部分患者声门闭合不全的治疗方法。本研究的目的是描述VFIA治疗PARD的应用情况及疗效。
对一家三级儿科护理中心2007年1月至2018年7月的病历进行回顾性分析。连续纳入接受VFIA治疗的PARD患者，这些患者在术前进行了嗓音评估，并在VFIA术后3个月内（使用脂肪、羧甲基纤维素凝胶、透明质酸）进行了随访评估。
34例患者（20例女性）接受了VFIA治疗。注射时的平均年龄为13.6岁（标准差6.1）。20例患者（58.8%）有早产史，平均接受过1.8次气道开放手术。注射后，29/34例患者（85.3%）表示主观嗓音有所改善。嗓音的基线共识听觉-感知评估（CAPE-V）总体严重程度评分平均下降5.7分（标准差=19.6），P = 0.12。儿童嗓音障碍指数（pVHI）总分提高了6.0分（标准差=19.5），从57.4分（标准差=20.0）降至51.4分（标准差=17.2），P = 0.09。功能性pVHI子评分有显著改善，下降了3.4分（标准差=7.3），P = 0.02。所有手术均在夜间观察下进行，未发生并发症。
PARD患者是一个复杂的患者亚群。VFIA是一种简单的干预措施，可能会改善嗓音感知。尽管客观测量改善不明显，但许多患者报告主观上有改善。有必要进一步开展工作以阐明注射治疗在PARD管理中的作用。
