{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T23:45:39Z","timestamp":1791762339049,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"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":["Clinical Otolaryngology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Unilateral vocal fold paralysis (UVFP) is a condition characterized by the loss of functional movement of one vocal fold resulting in incomplete glottic closure, which compromises essential functions such as phonation, swallowing and coughing. Injection medialization laryngoplasty can temporarily restore glottic closure, improving voice quality and potentially reducing the risk of aspiration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>A prospective cohort study was conducted from September 2024 to January 2026. Patients with UVFP were divided into early (&lt;\u20096\u2009months from the onset of paralysis) and late (\u2265\u20096\u2009months). All patients received injection medialization using hyaluronic acid (Perfectha Derm, 20\u2009mg\/mL). This was done either under local anaesthesia or under general anaesthesia. Voice assessment was done before injection and at 1 and 6\u2009months post\u2010injection, including maximum phonation time (MPT), GRBAS, acoustic analysis (jitter, shimmer, HNR) using PRAAT and patient\u2010reported Arabic Voice Handicap Index (VHI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010eight patients with UVFP were enrolled and divided into early (&lt;\u20096\u2009months) and late (\u2265\u20096\u2009months) groups. The early injection group showed significantly higher MPT at 1\u2009week and 6\u2009months. Fewer patients required Type I thyroplasty in the early injection group compared to patients who underwent later injection (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Long\u2010term acoustic measures were also superior in the early group, indicating better voice quality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early injection laryngoplasty was associated with superior long\u2010term voice outcomes and a significantly reduced need for permanent medialization surgery compared with late injection. These findings highlight the clinical importance of early intervention in the management of UVFP.<\/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":"10.1111\/coa.70179","type":"journal-article","created":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T23:25:40Z","timestamp":1791761140000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Versus Late Injection Laryngoplasty for Unilateral Vocal Fold Paralysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5406-3571","authenticated-orcid":false,"given":"Ahmed S.","family":"Abdelmeguid","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine Mansoura University  Mansoura Dakahlia Governorate Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3916-0343","authenticated-orcid":false,"given":"Mohamed Y.","family":"Elkotb","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine Mansoura University  Mansoura Dakahlia Governorate Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7911-004X","authenticated-orcid":false,"given":"Hemmat","family":"Baz","sequence":"additional","affiliation":[{"name":"Phoniatric Unit, Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine Mansoura University  Mansoura Dakahlia Governorate Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman A.","family":"Kamal","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine Mansoura University  Mansoura Dakahlia Governorate Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"issue":"4","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"398","DOI":"10.3390\/children11040398","article-title":"Management of Pediatric Bilateral Vocal Fold Paralysis: A State\u2010Of\u2010The\u2010Art Review of Etiologies, Diagnosis, and Treatments","volume":"11","author":"Lechien J. R.","year":"2024","journal-title":"Children"},{"issue":"7","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"NP294","DOI":"10.1177\/0145561320965212","article-title":"Causes of Vocal Fold Paralysis","volume":"101","author":"Wang H.\u2010W.","year":"2022","journal-title":"Ear, Nose & Throat Journal"},{"issue":"8","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1097\/00005537-200108000-00002","article-title":"Immediate Percutaneous Medialization for Acute Vocal Fold Immobility With Aspiration","volume":"111","author":"Anderson T. D.","year":"2001","journal-title":"Laryngoscope"},{"issue":"1","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1916-0216-42-24","article-title":"Evaluating the Timing of Injection Laryngoplasty for Vocal Fold Paralysis in an Attempt to Avoid Future Type 1 Thyroplasty","volume":"42","author":"Alghonaim Y.","year":"2013","journal-title":"Journal of Otolaryngology \u2010 Head & Neck Surgery"},{"issue":"10","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"2042","DOI":"10.1002\/lary.21097","article-title":"Early Versus Late Injection Medialization for Unilateral Vocal Cord Paralysis","volume":"120","author":"Friedman A. D.","year":"2010","journal-title":"Laryngoscope"},{"issue":"3","key":"e_1_2_10_7_1","first-page":"170","article-title":"Acoustic Voice Analysis Using the Praat Program: Comparative Study With the Dr. Speech Program","volume":"65","author":"Gonz\u00e1lez P.","year":"2014","journal-title":"Acta Otorrinolaringol\u00f3gica Espa\u00f1ola"},{"issue":"11","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1007\/s00405-010-1296-x","article-title":"Validation and Cultural Modification of Arabic Voice Handicap Index","volume":"267","author":"Malki K. H.","year":"2010","journal-title":"European Archives of Oto\u2010Rhino\u2010Laryngology"},{"key":"e_1_2_10_9_1","first-page":"1","volume-title":"Disorders of Human Communication","author":"Hirano M.","year":"1981"},{"issue":"5","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/S0030-6665(05)70267-X","article-title":"Phonosurgical Vocal Fold Injection: Procedures and Materials","volume":"33","author":"Rosen C. A.","year":"2000","journal-title":"Otolaryngologic Clinics of North America"},{"issue":"7","key":"e_1_2_10_11_1","first-page":"6","article-title":"Office\u2010Based Procedures for the Voice","volume":"83","author":"Simpson C. B.","year":"2004","journal-title":"Ear, Nose & Throat Journal"},{"issue":"10","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1097\/MLG.0b013e3180de4d49","article-title":"Vocal Fold Immobility: A Longitudinal Analysis of Etiology Over 20\u2009Years","volume":"117","author":"Rosenthal L. H. S.","year":"2007","journal-title":"Laryngoscope"},{"issue":"4","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/coa.12274","article-title":"Injection Laryngoplasty in the Outpatient Clinic Under Local Anaesthetic: A Case Series of Sixty\u2010Eight Patients","volume":"39","author":"Powell J.","year":"2014","journal-title":"Clinical Otolaryngology"},{"issue":"4","key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/coa.12516","article-title":"Outpatient\u2010Based Injection Laryngoplasty for the Management of Unilateral Vocal Fold Paralysis\u2013Clinical Outcomes From a UK Centre","volume":"41","author":"Mohammed H.","year":"2016","journal-title":"Clinical Otolaryngology"},{"issue":"1","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1007\/s12070-019-01642-w","article-title":"Vocal Fold Insufficiency: How Effective Is Injection Laryngoplasty? Short Term Clinical Outcomes","volume":"71","author":"Singh S.","year":"2019","journal-title":"Indian Journal of Otolaryngology and Head & Neck Surgery"},{"issue":"5","key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.otoeng.2017.08.008","article-title":"Electromyography\u2010Guided Hyaluronic Acid Injection Laryngoplasty in Early Stage of Unilateral Vocal Fold Paralysis","volume":"68","author":"Gotxi\u2010Erezuma I.","year":"2017","journal-title":"Acta Otorrinolaringologica"},{"issue":"6","key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1016\/j.jvoice.2011.11.007","article-title":"Laryngoplasty With Hyaluronic Acid in Patients With Unilateral Vocal Fold Paralysis","volume":"26","author":"Rudolf R.","year":"2012","journal-title":"Journal of Voice"},{"issue":"2","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/01.mlg.0000250898.82268.39","article-title":"Operating Room Versus Office\u2010Based Injection Laryngoplasty: A Comparative Analysis of Reimbursement","volume":"117","author":"Bov\u00e9 M. J.","year":"2007","journal-title":"Laryngoscope"},{"issue":"2","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1002\/lary.20737","article-title":"Current Practice in Injection Augmentation of the Vocal Folds: Indications, Treatment Principles, Techniques, and Complications","volume":"120","author":"Sulica L.","year":"2010","journal-title":"Laryngoscope"},{"issue":"6","key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"354","DOI":"10.24171\/j.phrp.2018.9.6.10","article-title":"Effects of Injection Laryngoplasty With Hyaluronic Acid in Patients With Vocal Fold Paralysis","volume":"9","author":"Kim G.\u2010H.","year":"2018","journal-title":"Osong Public Health and Research Perspectives"},{"issue":"4","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"427","DOI":"10.21053\/ceo.2019.00444","article-title":"Early Injection Laryngoplasty With a Long\u2010Lasting Material in Patients With Potentially Recoverable Unilateral Vocal Fold Paralysis","volume":"12","author":"Choi N.","year":"2019","journal-title":"Clinical and Experimental Otorhinolaryngology"},{"issue":"12","key":"e_1_2_10_22_1","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.3390\/medicina61122140","article-title":"Early Injection Laryngoplasty: Acoustic and Aerodynamic Outcomes With a Modified General Anesthesia Approach","volume":"61","author":"Altan E.","year":"2025","journal-title":"Medicina"},{"issue":"11","key":"e_1_2_10_23_1","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.3390\/biom11111580","article-title":"Long\u2010Lasting Effect After Single Hyaluronate Injection for Unilateral Vocal Fold Paralysis: Does Concentration Matter?","volume":"11","author":"Lee Y.\u2010C.","year":"2021","journal-title":"Biomolecules"},{"issue":"11","key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"7281","DOI":"10.1097\/JS9.0000000000001978","article-title":"Determinants of Clinical Response to Injection Laryngoplasty in Unilateral Vocal Fold Paralysis: A Systematic Review and Meta\u2010Analysis","volume":"110","author":"Safia A.","year":"2024","journal-title":"International Journal of Surgery"},{"key":"e_1_2_10_25_1","article-title":"Modulation of Brainstem\u2010Cortical Pathways by Injection Laryngoplasty in Unilateral Vocal Fold Paralysis: A Longitudinal Diffusion MRI Case Study","author":"Dedry M.","year":"2025","journal-title":"Journal of Voice"}],"container-title":["Clinical Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.70179","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/coa.70179","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.70179","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T23:25:44Z","timestamp":1791761144000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/coa.70179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,11]]},"references-count":24,"alternative-id":["10.1111\/coa.70179"],"URL":"https:\/\/doi.org\/10.1111\/coa.70179","archive":["Portico"],"relation":{},"ISSN":["1749-4478","1749-4486"],"issn-type":[{"value":"1749-4478","type":"print"},{"value":"1749-4486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,11]]},"assertion":[{"value":"2026-04-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"coa.70179"}}