Tragal Cartilage Versus Fascia Lata Implant for Treatment of Glottic Insufficiency: A Randomized Clinical Trial.

Background: 40 patients with glottic insufficiency over the age of 18 years old who presented to the otorhinolaryngology outpatient clinic at (blinded for peer review) were the subjects of this prospective study. Two equal groups (A&B) of patients were randomly separated. For group (A), the tragal cartilage implants were used to enhance the vocal folds; for group (B), fascia lata implants were utilized. Auditory perceptual assessment of voice (APA), voice handicap index (VHI), and computerized speech lab (CSL) were used for voice assessment, penetration aspiration score (PAS), and dysphagia handicap index (DHI) for aspiration assessment during preoperative and postoperative evaluation.

Results: In both groups, there was a statistically significant difference between preoperative and postoperative subjective and objective parameters used for voice and aspiration assessment (APA, VHI, CSL, PAS, and DHI). There was a statistically non-significant difference between the two groups one and 12 months postoperatively except for only noise to the harmonic ratio (N/H ratio) in group A which showed more significant improvement than group B.

Conclusion: Vocal fold augmentation using the tragal cartilage and fascia lata grafts in glottic insufficiency patients is effective in improving hoarseness of voice and aspiration. Both grafts result in long-term improvement (at least 12 months), however tragal cartilage graft is easier to implant and more stable postoperatively than the fascia lata graft.