Issue link: https://viewer.e-digitaledition.com/i/71333
M Vocal Cord Injection — A quick fix By Nicole Maronian, MD YTH: ONCE AN immobile vocal cord is diagnosed, the patient must wait a full year before any treatment can be performed to improve hoarseness. Reality: Vocal cord immobility or paralysis can occur due to a variety of causes including surgery, intubation, viral or other idiopathic etiologies. In most cases, the nerve needs to regrow from the point of injury which may take several weeks up to 1 ½ years. However, voice improvement can be provided at any point along that time line. Hoarseness can be a severe symptom after a vocal cord becomes weak or paralyzed. This results in time lost from work, swallowing difficulties and significant fatigue with vocalization. Historically, teratment consisted of a trip to the operating room for an open procedure to push the vocal cord back into a midline position, termed a medialization procedure. Although an excellent, permanent solution it was invasive and considered only if there was felt to be no hope for improvement in function. Vocal cord injection techniques fell out of favor when teflon granulomas become evident in the 1980s. However, since then multiple new injection materials have come onto the market and allowed easier and safer procedures. Like many areas of medicine, a return to office based, or minimally invasive procedures is true for this technique as well. Now, a patient can come into the office, be diagnosed with a vocal cord paralysis with severe hoarseness and walk out talking normally. These newer injection techniques provide a bridge to restore voice quickly while patients are waiting for natural recovery of function. The technique involves visualizng the vocal cords with a flexible endoscope. Topical anesthesia is applied to the vocal cords and an FDA approved material, Radiesse, is injected next to the vocal cord. This pushes the vocal cord toward the middle restoring normal laryngeal closure. Two types of injectables are available, one which is short term, lasting for 4-6 weeks and another which lasts from 3 months to longer than a year. Case Study Patient JB is a vigorous 75-year-old business man who underwent a routine carotid endartectomy. He awoke with hoarseness and an immobile vocal cord on flexible endoscopy. Watchful waiting was not a good option since he needed his voice for his livelihood. He underwent office based injection a few weeks after surgery and was able to return to work the very same day with return of normal voice. He has maintained good results over the last 11 months. Case Study LJ is a 63-year-old woman recently diagnosed with lung cancer. She developed sudden onset of hoarseness that resulted in a CT scan revealing her left upper lobe lesion. She started on chemotherapy occurring every 3 weeks. She was considering waiting for 6 months until all her treatments were complete before she treated her vocal cord. She was very hoarse but also aspirating with drinking liquids. Her treatment was customized to allow her injection to coincide with her treatment cycle so she did not miss any of her recommended infusions. She received an office based injection of Radiesse Voice, which normalized her voice and allowed her to complete all of her therapy uninterrupted. She reported that she could talk to her family again. "Before the injection, I was simply too tired." Dr. Nicole Maronian is director, Laryngology and Voice Disorders, Department of Otolaryngology-Head and Neck Surgery, at University Hospitals Case Medical Center in Cleveland. ■ JULY-AUGUST 2012 ■ MDNEWS.COM ■ MD NEWS Cleveland-Akron-Canton | 27 ++++++++++++++++++++ +++ +++ ++++++++++++++++++++ CASE STUDIES + +