About one in three individuals will experience some form of dysphonia in their lifetime, and need attention of speech-language pathologists. In dysphonia caused by glottic incompetence, a laryngologist may recommend medialization laryngoplasty as well. The most widely studied indication for this is unilateral vocal fold paralysis. This can cause a glottal gap that itself leads to dysphonia, or dysphagia or to respiratory sequelae. Type I thyroplasty, or vocal fold injection augmentation (VFIA), is now the common form of intervention. VFIA is an effective, temporary, and relatively low-risk treatment approach, particularly appropriate for glottal insufficiency that may resolve on its own. The procedure adds implant bulk or filler to vocal fold tissue, that indirectly presses the impaired fold toward the midline and facilitates glottic closure during phonation. The goal is to optimise the integrity of the vibratory margin. VFIA can be performed in the office, without the risks associated with general anesthesia. Type I thyroplasty is also becoming an option for patients requiring or preferring a more permanent resolution of their glottal insufficiency, as advancements in methods and materials continue to improve patient outcomes. The shape and makeup of implanted materials and the understanding of the underlying mechanisms of glottal insufficiency continue to improve. Computational modeling-based implant optimization and bioengineering of novel implantable materials are recently active research areas.
A complete review of medialization laryngoplasty for the benefit of speech-language pathologists exists in Wilson A, et al., J Speech Lang Hear Res. 2021 Feb 17;64(2):481-490. doi: 10.1044/2020_JSLHR-20-00344.
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