Skip to main content Accessibility help

A comparative study of voice outcomes and complication rates in patients undergoing injection laryngoplasty performed under local versus general anaesthesia: an Adelaide voice specialist's experience

  • D Chandran (a1), C Woods (a1), S Ullah (a2), E Ooi (a1) and T Athanasiadis (a1) (a3)...



To compare clinical outcomes and complication rates in patients undergoing injection laryngoplasty performed under local versus general anaesthesia.


A retrospective review was conducted of patients who underwent injection laryngoplasty performed by a single laryngologist in a tertiary Australian laryngology centre, between February 2013 and December 2014. Patient demographics, anaesthetic modality and complications were recorded. Voice Handicap Index 10 and the Grade, Breathiness, Roughness, Asthenia, Strain scale were evaluated.


Thirty-four laryngoplasties were performed under general anaesthesia and 41 under local anaesthesia, with mean patient ages of 59.5 and 68.8 years, respectively. Voice Handicap Index 10 scores were significantly improved post-injection (p < 0.001), with no significant difference between general anaesthesia and local anaesthesia (p > 0.05). All aspects of the Grade, Breathiness, Roughness, Asthenia, Strain scale showed significant improvement post-injection, except asthenia. There were seven (9.3 per cent) minor complications (five in the general anaesthesia group, two in the local anaesthesia group), all managed conservatively.


Injection laryngoplasties performed under general anaesthesia and local anaesthesia offer similar voice outcomes, with comparable complication rates. Hence, development of a management algorithm for injection laryngoplasties performed under local anaesthesia is recommended.


Corresponding author

Address for correspondence: Dr Theodore Athanasiadis, Flinders ENT, Department of Surgery, Flinders University and Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia Fax: +61 8 8204 7524 E-mail:


Hide All

Presented orally at the 65th Australian Society of Otolaryngology Head and Neck Surgery Annual Scientific Meeting, 4–7 March 2015, Sydney, Australia.



Hide All
1 Brünning, W. About a new treatment option for recurrent nerve paralysis [in German]. Verh Dtsch Laryg 1911;18:23
2 Courey, MS. Injection laryngoplasty. Otolaryngol Clin North Am 2004;37:121–38
3 Dedo, HH, Urrea, RD, Lawson, L. Intracordal injection of Teflon in the treatment of 135 patients with dysphonia. Ann Otol Rhinol Laryngol 1973;82:661–7
4 Ward, PH, Hanson, DG, Abemayor, E. Transcutaneous Teflon injection of the paralyzed vocal cord: a new technique. Laryngoscope 1985;95:644–9
5 Ellis, JC, McCaffrey, TV, Desanto, LW, Reiman, HV. Migration of Teflon after vocal cord injection. Otolaryngol Head Neck Surg 1987;96:63–6
6 Nakayama, M, Ford, CN, Bless, DM. Teflon vocal fold augmentation: failures and management in 28 cases. Otolaryngol Head Neck Surg 1993;109:493–8
7 Dedo, HH, Carlsöö, B. Histologic evaluation of Teflon granulomas of human vocal cords: a light and electron microscopic study. Acta Otolaryngol 1982;93:475–84
8 Bové, MJ, Jabbour, N, Krishna, P, Flaherty, K, Saul, M, Wunar, R et al. Operating room versus office-based injection laryngoplasty: a comparative analysis of reimbursement. Laryngoscope 2007;117:226–30
9 Sulica, L, Rosen, CA, Postma, GN, Simpson, B, Amin, M, Courey, M et al. Current practice in injection augmentation of the vocal folds: indications, treatment principles, techniques, and complications. Laryngoscope 2010;120:319–25
10 Mathison, CC, Villari, CR, Klein, AM, Johns, MM 3rd. Comparison of outcomes and complications between awake and asleep injection laryngoplasty: a case-control study. Laryngoscope 2009;119:1417–23
11 Jacobson, BH, Johnson, A, Grywalski, C, Silbergleit, A, Jacobson, G, Benninger, MS et al. The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol 1997;6:6670
12 Hirano, M. Clinical Examination of Voice. New York: Springer-Verlag, 1981
13 Birkent, H, Sardesai, M, Hu, A, Merati, AL. Prospective study of voice outcomes and patient tolerance of in-office percutaneous injection laryngoplasty. Laryngoscope 2013;123:1759–62
14 Portone, CR, Hapner, ER, McGregor, L, Otto, K, Johns, MM 3rd. Correlation of the Voice Handicap Index (VHI) and the Voice-Related Quality Of Life Measure (V-RQOL). J Voice 2007;21:723–7
15 Andrade Filho, PA, Carrau, RL, Buckmire, RA. Safety and cost-effectiveness of intra-office flexible videolaryngoscopy with transoral vocal fold injection in dysphagic patients. Am J Otolaryngol 2006;27:319–22
16 Damrose, EJ. Percutaneous injection laryngoplasty in the management of acute vocal fold paralysis. Laryngoscope 2010;120:1582–90
17 Carroll, TL, Rosen, CA. Trial vocal fold injection. J Voice 2010;24:494–8
18 Francis, DO, Dang, JH, Fritz, MA, Garrett, CG. Antiplatelet and anticoagulation therapy in microlaryngeal surgery. Laryngoscope 2014;124:928–34
19 Luu, Q, Tsai, V, Mangunta, V, Berke, GS, Chhetri, DK. Safety of percutaneous injection of bovine dermal crosslinked collagen for glottic insufficiency. Otolaryngol Head Neck Surg 2007;136:445–9
20 Mallur, PS, Rosen, CA. Vocal fold injection: review of indications, techniques, and materials for augmentation. Clin Exp Otorhinolaryngol 2010;3:177–82
21 Hertegård, S, Hallén, L, Laurent, C, Lindström, E, Olofsson, K, Testad, P et al. Cross-linked hyaluronan used as augmentation substance for treatment of glottal insufficiency: safety aspects and vocal fold function. Laryngoscope 2002;112:2211–19
22 Molteni, G, Bergamini, G, Ricci-Maccarini, A, Marchese, C, Ghidini, A, Alicandri-Ciufelli, M et al. Auto-crosslinked hyaluronan gel injections in phonosurgery. Otolaryngol Head Neck Surg 2010;142:547–53
23 Rosen, CA, Gartner-Schmidt, J, Casiano, R, Anderson, TD, Johnson, F, Reussner, L et al. Vocal fold augmentation with calcium hydroxylapatite (CaHA). Otolaryngol Head Neck Surg 2007;136:198204
24 Carroll, TL, Rosen, CA. Long-term results of calcium hydroxylapatite for vocal fold augmentation. Laryngoscope 2011;121:313–19
25 Hughes, RG, Morrison, M. Vocal cord medialization by transcutaneous injection of calcium hydroxylapatite. J Voice 2005;19:674–8


A comparative study of voice outcomes and complication rates in patients undergoing injection laryngoplasty performed under local versus general anaesthesia: an Adelaide voice specialist's experience

  • D Chandran (a1), C Woods (a1), S Ullah (a2), E Ooi (a1) and T Athanasiadis (a1) (a3)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed