Collagen Injection for the Elderly with Dysphonia

Abstract

Many patients who complain of age-associated voice changes exhibit insufficient glottic closure during phonation owing to vocal cord atrophy. Some patients with pre-existing conditions, such as recurrent laryngeal nerve paralysis and sulcus vocalis, also experience insufficient glottic closure during speech, which progresses as the laryngeal adjustment function deteriorates in an age-dependent manner. Therapeutic methods for insufficient glottic closure during phonation include the intracordal injection of collagen. The procedure is selected or used in combination with other treatments based on detailed preoperative examinations. Thus, treatment with collagen is not necessarily always performed. It can be administered as office-based surgery under local anesthesia and is minimally invasive as long as allergy is not a concern.

This treatment is ideally suited to patients with a narrow glottal gap or a decreased glottal mass and is also used in other cases as a component of combination therapy. There are some tips on performing this procedure successfully, which differ from one case to another. In cases of simple vocal cord atrophy, injections are made in the vocal ligament or vocal muscle to elevate the entire membranous part of the vocal cord. The key is to perform injections in such a manner that the area from the vocal cord edge to the inferior surface bulges. In some cases of sulcus vocalis or recurrent laryngeal nerve paralysis, injections are made in Reinke’s space to locally elevate the vocal cord edge.