Comparing Outcomes Between Voice Therapy and Injections for Vocal Fold Atrophy.

Objectives

Vocal fold atrophy is a common cause of dysphonia in older adults due to structural changes that impair glottic closure and vibration. Vocal fold injection augmentation (VFIA) and voice therapy are commonly used, but their relative efficacy and optimal sequencing remain unclear.

Methods

A retrospective chart review was conducted at a tertiary academic center over a 5-year period. Patients were categorized into four groups: VFIA, voice therapy, combined therapy, and observation. Outcomes included Voice Handicap Index-10 (VHI-10), Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) perceptual scores, and paired pre and post treatment stroboscopic findings. Within- and between-group changes were analyzed using parametric and nonparametric tests. An exploratory analysis evaluated treatment sequencing (VFIA→voice therapy vs. voice therapy→VFIA).

Results

Eighty patients were included (observation n = 32, VFIA n = 22, voice therapy n = 13, combined n = 12). Baseline VHI-10 differed significantly across groups (P < 0.001), with higher scores in the VFIA and combined cohorts, while baseline GRBAS scores were similar. VHI-10 improved within the combined (P = 0.041) and VFIA (P = 0.045) cohorts. Within-group perceptual improvement was observed for roughness and breathiness with combined therapy; breathiness with VFIA; and grade, roughness, and strain with voice therapy. Between-group comparisons of change scores were significant for grade (P = 0.035), roughness (P = 0.005), and breathiness (P = 0.018). Among patients with pre and post treatment stroboscopy, glottic insufficiency decreased following VFIA and combined therapy, while supraglottic hyperfunction increased in the observation group. In the sequencing analysis, voice therapy followed by VFIA was associated with greater improvement in grade (P = 0.040) and strain (P = 0.022).

Conclusion

VFIA and voice therapy may provide complementary benefits in vocal fold atrophy. Improvement in glottic closure was confined to cohorts receiving injection augmentation, whereas voice therapy was associated with greater improvement in roughness. Sequencing voice therapy before VFIA may improve perceptual outcomes, though small subgroup sizes limit inference.