{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T12:06:27Z","timestamp":1791806787432,"version":"4.3.4"},"reference-count":27,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004606","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG3K2041, CMRP3J1521-2"],"award-info":[{"award-number":["CMRPG3K2041, CMRP3J1521-2"]}],"id":[{"id":"10.13039\/501100004606","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["NMRPG3L0501"],"award-info":[{"award-number":["NMRPG3L0501"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Background: Early injection laryngoplasty (EIL) using hyaluronic acid (HA) is an effective treatment for glottic insufficiency in patients with acute unilateral vocal fold paralysis (UVFP). Most patients benefit by showing improvement in voice and quality of life and implied reduced need for permanent laryngoplasty. However, injected HA might resolve within a short period, so its long-term outcomes and the need for secondary procedures need to be clarified. Methods: Patients who underwent EIL with HA for acute UVFP from January 2015 to December 2018 were included. The factors that may associate with the prognosis including voice performance and laryngeal configuration at presentation, the cause of UVFP, and the type of HA for EIL were analyzed. Results: Ninety-four patients were included for analysis, with a mean follow-up period of 25.1 months (95% CI: 22.8\u201327.4 months). After primary HA injection, 22 patients (23.4%) underwent secondary procedures (rate: 13.1% per person-year), and most (63.6%) of the events occurred after one year from the first injection. The rate of secondary procedures within the first 12 months was 9.0% (14.1% and 4.3% for low-concentrated HA (LHA) and high-concentrated HA (HHA), respectively). The incidence of the secondary procedures was higher in the LHA group (18.2%) (p = 0.026) than in the HHA group (7.5%). Conclusions: The rate of secondary procedures was lower than the prediction based on the resorption time of HA, a finding that could be partly accounted for by both natural nerve recovery and a long-lasting effect of EIL. EIL with HHA had a lower rate of re-treatment than that with LHA, suggesting a better clinical utility for acute UVFP.<\/jats:p>","DOI":"10.3390\/biom11111580","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T23:49:52Z","timestamp":1635292192000},"page":"1580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Long-Lasting Effect after Single Hyaluronate Injection for Unilateral Vocal Fold Paralysis: Does Concentration Matter?"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6187-4102","authenticated-orcid":false,"given":"Yi-Chieh","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan"},{"name":"London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5986-0046","authenticated-orcid":false,"given":"Yu-Cheng","family":"Pei","sequence":"additional","affiliation":[{"name":"School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan"},{"name":"Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou and Taoyuan, 5 Fushing St., Taoyuan 333, Taiwan"},{"name":"Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, 5 Fushing St., Taoyuan 333, Taiwan"},{"name":"Healthy Ageing Research Center, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-An","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiu-Feng","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsueh-Yu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-595X","authenticated-orcid":false,"given":"Li-Ang","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7805-3458","authenticated-orcid":false,"given":"Tuan-Jen","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head & Neck Surgery, Chang Gung Memorial Hospital at Linkou, 5 Fushing St., Taoyuan 333, Taiwan"},{"name":"School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Taoyuan 333, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1002\/lary.24689","article-title":"Glottal gap as an early predictor for permanent laryngoplasty in unilateral vocal fold paralysis","volume":"124","author":"Fang","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_2","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","year":"2010","journal-title":"Laryngoscope"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1002\/lary.21965","article-title":"Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients","volume":"121","author":"Yung","year":"2011","journal-title":"Laryngoscope"},{"key":"ref_4","first-page":"121","article-title":"Early hyaluronate injection improves quality of life but not neural recovery in unilateral vocal fold paralysis: An open-label randomized controlled study","volume":"33","author":"Pei","year":"2015","journal-title":"Restor. Neurol. Neurosci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1002\/lary.26894","article-title":"Early-injection laryngoplasty may lower risk of thyroplasty: A systematic review and meta-analysis","volume":"128","author":"Vila","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1111\/j.1365-2273.2004.00876.x","article-title":"The role of glottal gap in predicting aspiration in patients with unilateral vocal paralysis","volume":"29","author":"Fang","year":"2004","journal-title":"Clin. Otolaryngol. Allied Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.cps.2016.03.016","article-title":"Hyaluronic Acid Fillers: Science and Clinical Uses","volume":"43","author":"Gutowski","year":"2016","journal-title":"Clin. Plast Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1097\/01.moo.0000144393.40874.98","article-title":"Injection laryngoplasty for management of unilateral vocal fold paralysis","volume":"12","author":"Kwon","year":"2004","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jvoice.2008.05.007","article-title":"Injection laryngoplasty with hyaluronic acid for unilateral vocal cord paralysis. Randomized controlled trial comparing two different particle sizes","volume":"24","author":"Lau","year":"2010","journal-title":"J. Voice"},{"key":"ref_10","first-page":"1091","article-title":"Juv\u00e9derm: A hyaluronic acid dermal filler","volume":"6","author":"Monheit","year":"2007","journal-title":"J. Drugs Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.jvoice.2016.11.014","article-title":"A Review of Hyaluronic Acid and Hyaluronic Acid-based Hydrogels for Vocal Fold Tissue Engineering","volume":"31","author":"Walimbe","year":"2017","journal-title":"J. Voice"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2744","DOI":"10.1002\/lary.27842","article-title":"Patient-defined duration of benefit from juvederm (hyaluronic acid) used in injection laryngoplasty","volume":"129","author":"Bertroche","year":"2019","journal-title":"Laryngoscope"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.jvoice.2014.01.010","article-title":"Safety and Length of Benefit of Restylane for Office-Based Injection Medialization\u2014A Retrospective Review of One Institution\u2019s Experience","volume":"28","author":"Halderman","year":"2014","journal-title":"J. Voice"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1177\/000348941312200901","article-title":"Prospective evaluation of office-based injection laryngoplasty with hyaluronic acid gel","volume":"122","author":"Upton","year":"2013","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1787","DOI":"10.1097\/MD.0000000000001787","article-title":"Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis","volume":"94","author":"Fang","year":"2015","journal-title":"Medicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.protcy.2014.10.138","article-title":"Jitter, Shimmer and HNR Classification within Gender, Tones and Vowels in Healthy Voices","volume":"16","author":"Teixeira","year":"2014","journal-title":"Procedia Technol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-0036-1597685","article-title":"Hyaluronic Acid Fillers in Soft Tissue Regeneration","volume":"33","author":"Fallacara","year":"2017","journal-title":"Facial Plast Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"71s","DOI":"10.1177\/0003489418805503","article-title":"Vocal Fold Injection of Absorbable Materials: A Histologic Analysis With Clinical Ramifications","volume":"128","author":"Zeitels","year":"2019","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_19","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":"Reiter","year":"2012","journal-title":"J. Voice"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1002\/lary.26156","article-title":"Inflammatory reaction to hyaluronic acid: A newly described complication in vocal fold augmentation","volume":"127","author":"Dominguez","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1097\/MLG.0b013e31802e9291","article-title":"Viscoelasticity of hyaluronan and nonhyaluronan based vocal fold injectables: Implications for mucosal versus muscle use","volume":"117","author":"Caton","year":"2007","journal-title":"Laryngoscope"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jvoice.2007.05.006","article-title":"Histological behavior of the vocal fold after hyaluronic acid injection","volume":"23","author":"Perazzo","year":"2009","journal-title":"J. Voice"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S1808-8694(15)31063-6","article-title":"A study of the histological behavior of a rabbit vocal fold after a hyaluronic acid injection","volume":"73","author":"Perazzo","year":"2007","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S199","DOI":"10.1002\/lary.21666","article-title":"Voice outcomes after endoscopic injection laryngoplasty with hyaluronic acid stabilized gel","volume":"120","author":"Song","year":"2010","journal-title":"Laryngoscope"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.surg.2009.02.005","article-title":"Intracordal fat assessment by 3-dimensional imaging after autologous fat injection in patients with thyroidectomy-induced unilateral vocal cord paralysis","volume":"146","author":"Fang","year":"2009","journal-title":"Surgery"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1002\/lary.25431","article-title":"Effect of injection augmentation on need for framework surgery in unilateral vocal fold paralysis","volume":"126","author":"Francis","year":"2016","journal-title":"Laryngoscope"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"629","DOI":"10.2147\/CIA.S3118","article-title":"Hyaluronic acid gel (Juv\u00e9derm) preparations in the treatment of facial wrinkles and folds","volume":"3","author":"Baumann","year":"2008","journal-title":"Clin. Interv. Aging"}],"container-title":["Biomolecules"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2218-273X\/11\/11\/1580\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:23:34Z","timestamp":1760167414000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2218-273X\/11\/11\/1580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,26]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["biom11111580"],"URL":"https:\/\/doi.org\/10.3390\/biom11111580","relation":{},"ISSN":["2218-273X"],"issn-type":[{"value":"2218-273X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,26]]}}}