Vocal Fold Injection Augmentation
When there is gap between the vocal folds on attempted voice production, usually from vocal fold paralysis or paresis, the result is a breathy voice that fatigues easily. Smaller gaps can be treated with injections into the vocal folds to “plump” them and increase contact time during voice production. There are a number of different substances available for injection, and most surgeons agree that the “perfect” substance has not yet been discovered.
Fat from your own abdomen is an excellent substance for vocal fold injection, particularly for small gaps between the vocal folds. This procedure is performed in the operating room under general anesthesia. A small incision is made in the belly, and the vocal fold injection is performed through the mouth without incisions on the neck. The fat tends to be absorbed by the body, so a generous injection is always performed to account for the later loss of fat. A one-night hospital stay is required. Whatever fat remains in the vocal fold at 3 months after surgery is likely to remain for the rest of your life.
Collagen and calcium hydroxylapatite are other common injectables. Collagen lasts approximately 6 months, and calcium hydroxylapatite usually lasts for years. These procedures are performed in the operating room or in the office, and do not require any incisions. Blood thinners (such as aspirin, Coumadin, or Plavix) do not have to be stopped prior to operating room procedures with these substances. Usually a hospital stay is not required.
More temporary substances are available for injection which allow for short term voice improvement when the vocal fold problem is expected to recover on its own.
You will be asked to be on strict voice rest at least 3 days after all vocal fold injection procedures. Since your surgeon will always over-inject the vocal folds to account for loss of the substance over time, your voice may actually be worse for a few weeks after surgery. This is a normal course of events and appropriate voice use is particularly important during the recovery period. All vocal fold injections have a 10-15% revision rate, meaning that 1-2 out of 10 people will need another voice procedure in their lifetime.