Diagnostic vocal fold injection as an intervention for secondary muscle tension dysphonia

Abstract Objectives In this review, we draw on the available evidence supporting use of a diagnostic vocal fold injection as part of the treatment paradigm for secondary muscle tension dysphonia when voice therapy incompletely addresses patient’s voice and laryngeal related symptoms. We aim to outline some key diagnostic and treatment considerations, focussing on the search for underlying glottic insuffiency, and role of a diagnostic vocal fold augmentation for the patient with secondary muscle tension dysphonia. Methods A literature review of PubMed was performed, titles and abstracts were assessed, and articles that most comprehensively addressed our clinical question were selected. We also draw upon the authors’ experience with the management of secondary muscle tension dysphonia. A representative case presentation along with review of classification, diagnosis, work-up and management of muscle tension dysphonia in the setting of glottic insuffiency is presented. Conclusions Glottic insuffiency resulting in secondary muscle tension dysphonia is an under-recognised contributor to voice and laryngeal related complaints. When behavioural treatments are unsuccessful, a diagnostic vocal fold injection is a relatively simple method to determine if addressing underling the glottic insufficiency affords symptomatic improvement. If a favourable response is obtained, it is reasonable for both patient and treating surgeon to proceed with a more durable or even permanent augmentation option.