Platelet Rich Plasma for benign vocal fold pathology: a pilot study

Abstract

Introduction: Dysphonia due to disruption of the unique structure of the vocal fold lamina propria (vocal fold scar, atrophy, sulcus and inflammatory lesions) is notoriously difficult to treat. Current medialisation treatments act to reduce glottic insufficiency but cannot restore the structural disarray within the lamina propria, and give underwhelming results for many patients. Research in biological and tissue engineering treatments has been gaining momentum, due to their potential to regenerate the lamina propria, but are difficult to produce and expensive. Platelet rich plasma (PRP) is widely used in other areas of medicine, for it’s wound healing effects attributed to the growth factor and cytokine milieu, that promote tissue regeneration and remodelling, and because it is time and cost effective. Studies of PRP application to the larynx are few, and display limited follow up in small patient groups. Our aim was to administer PRP to the larynx for a wide range of benign VF pathology, and to review short- and medium-term phonatory outcomes. Methods: Individuals with dysphonia due to vocal pathology of the lamina propria were included. Participants received bilateral PRP intrachordal injections. Subsequent injections were offered depending on clinical progression. Outcome measures of Vocal handicap index -10 (VHI-10), vocal fatigue index (parts 1,2 and 3) (VFI-1,2,3), maximum phonation time (MPT), GRBAS(grade, roughness, breathiness, asthenia, strain), stroboscopy analysis and patient reported outcomes were included. Follow up was undertaken at 1 week, 1 month, 3 months and 6 months. Paired T tests were used to assess pre- and post-injection outcomes at each time point. Results: 24 participants were included in outcome analysis. Statistically significant improvement in VHI-10, VFI-1, VFI-2, G (GRBAS), R(GRBAS) were seen at 1,3 and 6 months. Mean decrease in VHI-10 at 6 months from baseline was 5.6 [p=0.012]. 23/24 participants would consider a future injection. MPT at baseline was 13.4s and improved to 16.9s [p=0.027] by 3 months. Stroboscopic data saw improvements in glottic gap, and mucosal wave propagation. There were no adverse reactions. No adverse events occurred. Treatment was cost and time efficient. Conclusion: PRP is a safe, cost-effective treatment for lamina propria-related vocal pathology. Improvements in phonatory outcomes were seen across a range of disease types and severities out to 6 months. Further research needs to be undertaken to determine optimal injection volume and frequency and durability of responses.