Calcium Hydroxylapatite Paste for Vocal Rehabilitation

• Published in: Otolaryngology-head and neck surgery 2008-08, Vol.139 (2), p.P49-P49
• Main Authors: Gillespie, Marion B, Curry, Jason A, Dozier, Thomas S
• Format: Article
• Language: English
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1016/j.otohns.2008.05.158

Objective Determine the effectiveness of calcium hydroxylapatite paste in vocal rehabilitation in routine clinical practice. Methods Retrospective series of adult patients undergoing calcium hydroxylapatite paste injection for vocal fold rehabilitiation over a 3-year period. Outcomes include change in Voice Handicap Index (VHI) scores, procedure-related complications, and need for follow-up vocal procedures. Results A total of 23 patients with an average age of 65 years underwent vocal fold rehabilitation with calcium hydroxylapatite injection performed by operative endoscopy. Indications for injection included recurrent laryngeal nerve paralysis in 17 patients and partial cordectomy defects in 6 patients. There were no observed procedure-related complications. Following injection, 17 patients (74%) had improvement in voice as measured by VHI, 4 had worsening of voice, and 2 were essectially unchanged from baseline. The mean VHI scores improved from 66 (S.D. 4.4) to 35 (S.D. 4.5) after a mean follow-up time of 2 months (p=0.00001). There was a non-significant trend toward greater improvement in the VHI scores for the paralysis group compared to the cordectomy group (p=0.09). Six patients required subsequent vocal procedures after the first injection to improve the voice, 4/6 in the cordectomy group and 2/17 in the paralysis group (p=0.02). Conclusions Calcium hydroxylapatite injection results in significantly improved vocal scores in the majority of patients. The paste was less satisfactory in patients with cordectomy defects due to poor retention of paste in the scarred vocal remnant. External medialization is usually required in these cases in order to adequately mobilize the scar to produce the volume necessary for satisfactory voice.