Vocal fold augmentation for presbyphonia in the aging singer: effect on singing voice handicap

Objectives: Diagnostic vocal fold injection augmentation with carboxymethylcellulose (CMC) has been described and widely used as a “test drive” for symptom improvement in patients with presbyphonia. Many patients with presbyphonia and speaking voice complaints are also avid amateur singers, or former professional singers, who have lost range, reliability and/or confidence in their singing voice. This study intends to evaluate diagnostic CMC injection augmentation outcomes in patients who have presbyphonia and are self-reported singers. It is hypothesized that in patients with presbyphonia who had improvement in their voice handicap index-10 (VHI) or cough severity index (CSI) (depending on their presenting complaint) after diagnostic vocal fold injection augmentation, that their singing voice handicap index (SVHI) score will also improve.

Methods: Retrospective Review. Patients who underwent diagnostic carboxymethylcellulose (CMC) injection augmentations via office-based, per-oral approach for presbyphonia (bilateral vocal fold atrophy with glottic insufficiency at modal pitch identified on stroboscopy) between 2019 – present were identified through a proprietary intake questionnaire database. Subjects were included if they also self-identified as being a singer through the same intake questionnaire. Subject demographics, diagnoses, and volume/sidedness of CMC injected will be reported. Pre- and post-injection change in the SVHI will be the primary outcome measure; Acoustic measures, VHI and CSI at 2- 4 weeks will be reported where available.

Results: Pre and post SVHI, VHI and CSI are collected automatically with every intake survey completed at all patient visits during the time period, and analysis is forthcoming. Acoustic measures are obtained at the pre- and 2–4-week post CMC augmentation visits. The expected number of subjects presented will likely grow before the Symposium.

Conclusion: Injection augmentation for singers with presbyphonia is not reported sufficiently in the laryngology literature. Pre/post patient SVHI outcomes after CMC gel augmentation for presbyphonia in patients who self-identify as singers will be reported.