Office-Based Vocal Cord Injections | Laryngeal Bevacizumab (Avastin) Injections | Laryngeal Botox Injections | Office-Based KTP Laser Treatment
Dr. Aaron D. Friedman discusses office-based treatment for vocal cord paralysis.
Office-Based Vocal Cord Injections (Injection Laryngoplasty) for Vocal Cord Paralysis
Typically vocal cord injections are performed to provide temporary improvement of voice for unilateral (one-sided) vocal cord paralysis when recovery of vocal cord motion is uncertain. During the procedure a video laryngoscope is used, through the patient’s mouth, to provide magnified visualization and lighting.
After application of numbing medicine to the throat, a small needle on a long curved syringe is inserted through the mouth, into the throat, and into the paralyzed the vocal cord. During the procedure, a filling will be placed with the paralyzed vocal cord, pushing it towards the middle of the airway to help close the leaking vocal cord valve that typically results from unilateral vocal cord paralysis. Once the needle is introduced in the vocal cord, the actual injection takes just a minute or so.
In addition to avoiding general anethesia and a lengthy recovery, office-based injection laryngoplasty has the advantage of allowing the patient to be completely awake and able to try out his or her new voice right after the injection. If too little material has been injected into the vocal cord, this can be easily visualized and heard in the completely awake patient, unlike in the operating room. This permits an injection to be performed immediately, if necessary, to optimize the vocal results.
The entire procedure lasts approximately ten minutes, and patient may leave the office immediately afterwards. Many times, a patient's voice will be dramatically improved immediately following the injection.
Laryngeal Bevacizumab (Avastin) Injections
Laryngeal bevacizumab (Avastin) injections are typically performed after KTP laser surgery, as an additional treatment for recurrent laryngeal papillomatosis. Avastin is usually injected directly into the vocal cord(s) but it can also be injected into other parts of the larynx that are affected by significant amounts of papilloma.
Laryngeal Avastin Injections can be administered in the operating room or in the office. Because the injections usually follow office-based KTP laser surgery when given in the office, little additional preparation is needed, as numbing medicine has already been given for the laser procedure. The technique is essentially the same as an office-based injection laryngoplasty, except that the medication is delivered into a more shallow portion of the vocal cord(s). Preliminary investigations have shown that bevacizumab does not harm vocal cord vibration and that it may reduce the frequency of treatments required for laryngeal papillomatosis.
Laryngeal Botox Injections
Botulinum toxin (Botox) is a drug that temporarily reduces the strength of contraction in the muscle into which it is injected. For the purposes of voice disorders, it is helpful in managing a neurologic condition called spasmodic dysphonia, as well as an unrelated condition called an arytenoid granuloma. It can usually be injected into the larynx in the office as opposed to the operating room.
Office-Based KTP Laser Treatment
Chronic laryngeal conditions such as laryngeal papillomatosis and vocal cord dysplasia may require multiple treatments. In most cases, this would mandate multiple trips to the operating room under general anesthesia. However, at our Voice Center we can treat many patients with these chronic diseases in the office, without anesthesia, after their disease has first been initially controlled in the operating room.
The procedure begins with the application of numbing medicine into the nose and the throat. Then, a flexible scope attached to a light source and video monitor is advanced into the nose and the back of the throat. Additional numbing medicine is applied to the voice box directly through a small hollow channel in the scope.
After adequate anesthesia is achieved, a flexible glass fiber is inserted into the channel of the scope, which is then advanced down to the larynx and vocal cords. The other end of the glass fiber is attached to the KTP laser. The laser fiber is then directed towards the appropriate areas and used to selectively treat the disease.
Because of the previously applied numbing medication, there is typically no discomfort. Patients must simply breathe and refrain from swallowing or talking for short periods of time during use of the laser.
In total, the procedure takes approximately 10 to 15 minutes, and patients may leave the office soon thereafter, avoiding the recovery time that typically occurs following general anesthesia.
For More Information
For more information or to schedule an appointment, please call 847.504.3300.