Glottic insufficiency; Autologous fat augmentation; Calcium hydroxylapatite; Voice handicap index; Maximal phonation time

Purpose To evaluate 5-year voice outcomes of vocal fold augmentation (VFA) using autologous fat (AF) injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection. Methods Retrospective study of patients who underwent VFA between 2012 and 2015, with a 5-year follow-up. Patients with a glottic gap of <= 3 mm caused by unilateral vocal fold paralysis or vocal fold atrophy were included in the study. VFA was performed using AF injection via direct microlaryngoscopy in 17 patients, and using office-based CaHA injection in 19 patients. Subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection, and at 12 and 60 months post-VFA. Results Altogether 36 patients underwent VFA between 2012 and 2015, of whom 5 were excluded within 1 year post-VFA, and 2 were excluded between 1 and 5 years post-VFA. Of the remaining 29 patients, 3 (10.3%) underwent re-intervention at between 1 and 3 years post-VFA. Thus, the 5-year follow-up included 26 patients (72.2%; 11 males and 15 females). At 5 years after surgery, 73.1% of the patients were satisfied with their voice, with no significant between-group difference (P = 0.307). The mean improvement of VHI was 28.8 +/- 17.82 in the autologous fat group versus 33 +/- 26.24 in the CaHA group (P = 0.458). MPT improvement was also similar between the two groups: 6.2 +/- 4.26 for the autologous fat group versus 6.3 +/- 4.34 for the CaHA group (P = 0.667). Conclusions Both AF injection via direct microlaryngoscopy and office-based CaHA injection yielded good and comparable 5-year results.