Safety and efficacy of carboxymethylcellulose in the treatment of glottic insufficiency

Authors

  • Pavan S. Mallur MD,

    1. Department of Surgery, Division of Otolaryngology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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  • Michele P. Morrison DO,

    1. Department of Otolaryngology, Center for Voice and Swallowing, Georgia Health Sciences University, Augusta, Georgia
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  • Gregory N. Postma MD,

    1. Department of Otolaryngology, Center for Voice and Swallowing, Georgia Health Sciences University, Augusta, Georgia
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    • Gregory N. Postma, MD, Milan R. Amin, MD, and Clark A. Rosen, MD, are consultants and speakers for Merz Aesthetics, Inc. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

  • Milan R. Amin MD,

    1. Department of Otolaryngology, New York University Voice Center, NYU School of Medicine, New York, New York, U.S.A
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    • Gregory N. Postma, MD, Milan R. Amin, MD, and Clark A. Rosen, MD, are consultants and speakers for Merz Aesthetics, Inc. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

  • Clark A. Rosen MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Voice Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    • Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Voice Center, 1400 Locust Street, Building B, Suite 11500, Pittsburgh, PA 15219
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    • Gregory N. Postma, MD, Milan R. Amin, MD, and Clark A. Rosen, MD, are consultants and speakers for Merz Aesthetics, Inc. The authors have no other funding, financial relationships, or conflicts of interest to disclose.


  • Presented at the Annual Meeting of the Triological Society, Chicago, Illinois, U.S.A., April 29–30, 2011.

Abstract

Objectives/Hypothesis:

No studies to date have examined the clinical safety and efficacy of carboxymethylcellulose (CMC) for vocal fold injection. The current study investigates the voice outcomes and complications of CMC injection.

Study Design:

Retrospective review.

Methods:

All patients who underwent CMC injection from three independent sites in a 1-year period were reviewed. Voice outcomes in the form of voice handicap index-10 (VHI-10) and complications from injection were recorded.

Results:

Seventy-eight patients with VHI-10 results from 1 to 8 weeks after CMC injection were evaluated. Thirty-eight patients were treated for vocal fold immobility, and 15 patients underwent treatment for hypomobility, 15 for vocal fold atrophy, seven for scar/sulcus, one for previous laryngeal fracture, one for functional dysphonia, and one for persistent granuloma. In 60 patients with available VHI-10 data, overall improvement in voice was seen. There was a mean decrease in VHI-10 of 7.48 (26.4 to 18.9, P < .05), correlating to a 19.9% decrease. Forty-five patients (75%) showed a decrease in VHI-10, nine (15%) showed an increase, and six (10%) showed no change. Statistically significant differences were seen for patients with immobility (decrease of 8.6, or 31%) and hypomobility (decrease of 10.7, or 37.8%). There were no complications of vocal fold stiffness, inflammatory reaction, or scar in the 78 patients during the total follow-up period.

Conclusions:

CMC is a viable, safe, and efficacious material for the temporary treatment of glottic insufficiency in vocal fold immobility and hypomobility, with minimal risk of permanent adverse voice outcomes.

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