Systematic Review of Voice Outcomes for Injection Laryngoplasty Performed under Local vs General Anesthesia

Abstract

Objective: To assist otolaryngologists in counseling patients with hoarseness who would benefit from injection laryngoplasty on whether or not to perform the procedure in the office vs the operating room. Data Sources: Cochrane library, CINAHL, PubMed, and EMBASE. Review Methods: Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting standards of English-language articles that compared voice outcomes for in-office and in the operating room injection laryngoplasty. Two independent investigators assessed study eligibility, rated the quality using Methodological Index for Non-Randomized Studies (MINORS), and abstracted data for comparative analysis. Results: Of 689 initial studies, 4 observational, comparative studies met inclusion criteria, with follow-up of 2 weeks to 12 months postinjection. Laryngoplasty was most commonly performed for vocal fold immobility with varied injectable materials (micronized dermis, hyaluronic acid, and calcium hydroxyapatite). Follow-up ranged from 2 weeks to 12 months. Voice outcomes improved in all studies, with comparable improvement for patients injected in the office vs the operating room (P =.42 to P =.88). Meta-analysis of 3 studies showed no difference in Voice Handicap Index–10 voice outcomes by treatment setting (standardized mean difference −0.11, P =.441), with the 95% confidence interval (–0.405 to 0.176), making it unlikely that anything larger than a small or trivial difference was missed. Conclusion: Our systematic review makes it unlikely that meaningful clinical differences exist in postprocedure voice outcomes for injection laryngoplasty in the office vs the operating room.