Vocal cord medialization by transcutaneous injection of calcium hydroxylapatite.

Transcutaneous vocal cord augmentation has increasingly become the method of choice when treating causes of vocal cord insufficiency. Many substances have accompanied this technique, but they all have problems. One newer substance is calcium hydroxylapatite (CaHA). CaHA may produce fewer problems and offer a longer-lasting treatment. Twenty-one patients were treated in the Pacific Voice Clinic with trancutaneous injection of CaHA for vocal cord paralysis (n = 19) and vocal scarring (n = 2). Maximum phonation time (MPT) was the measure of vocal performance. An improvement was seen in 20 patients with the MPT, who improved from 4.6 seconds before treatment to 10.8 seconds at posttreatment of 3 months (n = 15). This improvement was maintained at 6 months (MPT = 12 seconds, n = 12). Follow-up was incomplete because of the terminal nature of some diagnoses and the large geographical area covered by the clinic. Three subjects had submucosal injection of CaHA (two resolving spontaneously). Two other patients had extrusion of the material. With short-term and medial-term follow-up on a small group of patients, encouraging results were seen with transcutaneous injection of CaHA for vocal cord augmentation.