Long-term results of calcium hydroxylapatite for vocal fold augmentation

Objectives/hypothesis: Studies have shown excellent results for 12-month post-injection augmentation data for calcium hydroxylapatite (CaHA) for glottal incompetence; however, the longevity of the material past one year was unknown. Our objective was to report the long-term effectiveness of CaHA as a vocal fold injectable by assessing data from a cohort of patients who underwent injection for glottal insufficiency.

Study design: Retrospective chart review.

Methods: Patients who underwent CaHA injection for glottal insufficiency of any etiology were considered for inclusion in the study. The change in Voice Handicap Index (VHI)-10 scores between preinjection scores and best postinjection scores as well as between the preinjection and the most recent VHI-10 scores were used as primary outcome measures to determine the persistence of benefit or the time to loss of benefit. Complications among the cohort were identified.

Results: Ninety patients who underwent 108 vocal fold injections with CaHA were evaluated for inclusion. Twenty patients with 22 injections met the criteria for inclusion. Fourteen of 22 (64%) subjects showed loss of benefit of the CaHA material. The average length of benefit was 18.6 months, with a range of 8 to 36 months. Three complications were identified among the original cohort of 108 injections.

Conclusions: CaHA remains a safe and effective long-term vocal fold injectable with an average length of benefit of 18.6 months. Three complications were seen among 108 CaHA injections. CaHA is a long-term injectable with an excellent track record that does not appear to warrant concern for permanent or late complications.