Office-based transnasal injection laryngoplasty with cross linked hyaluronic acid in unilateral vocal fold palsy: long-term results

Objective. To assess long-term phonatory outcomes of office-based injection laryngoplasty with cross-linked hyaluronic acid (HA) via transnasal flexible endoscopic phonosurgery (FEPS), followed by voice therapy, in patients with unilateral vocal fold palsy (UVFP).
Methods. Retrospective study on 20 UVFP patients treated with HA via FEPS within 6 months from diagnosis. All underwent postoperative voice rehabilitation. Voice outcomes were assessed at baseline (T0), and at 3 (T1), 12 (T2), and 24 (T3) months using
Maximum phonation time (MPT), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI), GRBAS rating scale, and Voice Handicap Index-10 (VHI-10).
Results. MPT, CPPS, and AVQI improved significantly at T1, remaining stable at T2 and T3. GRBAS scores showed marked improvement at T3. Videolaryngostroboscopy confirmed better glottic closure and vocal fold vibration. VHI-10 scores decreased consistently, indicating reduced voice handicap.
Conclusions. FEPS-guided HA injection is a safe, effective, and minimally invasive treatment for UVFP, ensuring lasting voice improvements, especially when performed early and combined with voice therapy. This strategy may reduce the need for open surgery in selected cases.