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Intracordal Hyaluronic Acid Injection during Spontaneous Reinnervation Stage for Unilateral Recurrent Laryngeal Nerve Paralysis

Objectives: The effect of intracordal hyaluronic acid (HA) injection is considered an effective temporary treatment for acute unilateral vocal fold paralysis (UVFP),but its long term benefit is not concluded. This project proposed to evaluate the long term benefit from HA injection. Study design: Prospective randomized case study. Methods: From August 2011 to January 2013, 40 consecutive subjects diagnosed with acute UVFP were enrolled. The subjects were randomized into two groups. Group A accepted transcervical HA injection at 6 months from symptoms appearing. Group B subjects accepted the conventional observation policy. All patients had performed serial videostroboscopy, acoustic voice measurements, and two questionnaires (Voice Outcome Survey and SF-36) till 12 months. Results: Thirty-five patients were evaluated completely and followed up regularly. Three of them returned their vocal fold motion, and one within adequate injection were excluded. There were 16 cases in group A and 15 cases in group B. At the last visit, the vocal cord position, evidenced by normalized glottal gap area; maximal phonation time, jitter, H/N, VOS showed significant improvement in both groups compared to initial evaluation. In SF-36 measurements, 3 of 8 domains including role limitation due to physical health, vitality, and mental health improved in group A but not in group B. Data comparison between groups showed no significant differences at the end of follow-up. Conclusions: Intracordal HA injection is an effective therapy for acute UVFP. However, the long term result is not significantly different from conventional observation policy.