{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:07:58Z","timestamp":1789186078826,"version":"build-2803163510"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the safety and efficacy of silk protein\u2013hyaluronic acid (silk\u2010HA) injection laryngoplasty for glottic insufficiency at an independent tertiary academic voice center and compare outcomes and complication rates with those of HA injection augmentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed patients undergoing SilkVoice augmentation between June 2022 and August 2025 at a single institution. Outcomes included patient\u2010reported vocal improvement, emergency department visits, hospitalizations, and operative interventions. For patients with prior HA injection, silk\u2010HA outcomes were compared using a within\u2010patient design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010three patients underwent 44 silk\u2010HA injections (mean age 73.4\u2009years; 51.5% female). Outcome data were available for 29 patients (87.9%). Most procedures (95.5%) were office\u2010based with a mean follow\u2010up of 12.7\u2009months. Overall, 86.2% of patients reported at least minimal vocal improvement and 79.3% reported partial to significant improvement. In a within\u2010patient comparison of 20 patients who received both silk\u2010HA and prior HA, median improvement scores were equivalent (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.776). Compared with a historical HA cohort from the same institution (691 patients, 1146 injections), operative intervention was significantly higher in silk\u2010HA (6.8% vs. 0.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005); two cases were elective revisions for overaugmentation, and one occurred in the setting of lung cancer progression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Silk\u2010HA injection laryngoplasty demonstrates safety and efficacy for glottic insufficiency with voice outcomes comparable to HA and no increase in serious adverse events despite higher operative revision rates. These findings from an independent academic voice center provide external validation supporting silk\u2010HA as a viable office\u2010based augmentation option.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70665","type":"journal-article","created":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T01:59:46Z","timestamp":1780711186000},"page":"4354-4360","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Silk\u2013Hyaluronic Acid Laryngoplasty Outcomes: An Independent Tertiary Center Experience"],"prefix":"10.1002","volume":"136","author":[{"given":"Benjamin","family":"Wajsberg","sequence":"first","affiliation":[{"name":"Cleveland Clinic Voice Center, Department of Otolaryngology Head and Neck Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6325-3417","authenticated-orcid":false,"given":"Anastasia M.","family":"Christ","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8032-5291","authenticated-orcid":false,"given":"Sarah E.","family":"Benyo","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Voice Center, Department of Otolaryngology Head and Neck Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor A.","family":"Keuchel","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3368-5822","authenticated-orcid":false,"given":"Radhika","family":"Duggal","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Voice Center, Department of Otolaryngology Head and Neck Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Wu","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Voice Center, Department of Otolaryngology Head and Neck Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1908-397X","authenticated-orcid":false,"given":"Michael S.","family":"Benninger","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Voice Center, Department of Otolaryngology Head and Neck Institute, Cleveland Clinic  Cleveland Ohio USA"},{"name":"Cleveland Clinic Lerner College of Medicine, Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca C.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Voice Center, Department of Otolaryngology Head and Neck Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul C.","family":"Bryson","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Voice Center, Department of Otolaryngology Head and Neck Institute, Cleveland Clinic  Cleveland Ohio USA"},{"name":"Cleveland Clinic Lerner College of Medicine, Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7371-9364","authenticated-orcid":false,"given":"William S.","family":"Tierney","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Voice Center, Department of Otolaryngology Head and Neck Institute, Cleveland Clinic  Cleveland Ohio USA"},{"name":"Cleveland Clinic Lerner College of Medicine, Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31817e7431"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/978-3-031-34354-4","volume-title":"Operative Techniques in Laryngology","author":"Rosen C. A.","year":"2024"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000540"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2003.12.002"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.14307"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818780207"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3342\/ceo.2010.3.4.177"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405\u2010022\u201007437\u20100"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2018.01.017"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27618"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2024.02.025"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2025.07.019"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70665","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.70665","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T03:22:56Z","timestamp":1789183376000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.70665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":12,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/lary.70665"],"URL":"https:\/\/doi.org\/10.1002\/lary.70665","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]},"assertion":[{"value":"2026-03-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}