The Use of Hyaluronic Acid in the Treatment of Unilateral Vocal Fold Paralysis: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Unilateral vocal fold paralysis (UVFP) is a neurological condition characterized by glottal insufficiency, commonly resulting from iatrogenic damage sustained during head and neck surgery. Hyaluronic acid (HA), a naturally occurring glycosaminoglycan, has been shown to influence vocal cord function positively. This study aimed to evaluate the effectiveness of HA in treating UVFP. A systematic review and meta-analysis were conducted following the PRISMA guidelines (PROSPERO ID: CRD42024560084). Literature searches were performed in PubMed, Cochrane Library, Web of Science, and Google Scholar up to August 2024 using a comprehensive combination of terms related to HA and UVFP. Two independent reviewers conducted study selection, data extraction, and quality appraisal using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomized controlled trials. Thirty-two studies involving 1,917 adult patients were included. Outcomes assessed included quality of life (QOL), maximal phonation time (MPT), and normalized glottal gap area (NGGA). Meta-analysis demonstrated significant short- and medium-term improvements in patient-reported QOL following HA injection (standardized mean difference [SMD]=0.87, 95% CI [0.65-1.09]; p < 0.0001; I²=0%). Medium-term MPT also improved significantly (SMD=0.45, 95% CI [0.16-0.74]; p=0.003; I²=2%). Similarly, NGGA improved in the medium term (SMD=0.51, 95% CI [0.19-0.83]; p=0.002; I²=0%). Adverse events were rare and mostly minor, including transient dysphonia and inflammation. The overall risk of bias was low in most included studies. HA injection laryngoplasty appears effective in improving vocal function and quality of life in patients with UVFP in the short to medium term. However, the current evidence is limited by variable follow-up durations, technique heterogeneity, and insufficient long-term data. Future studies should explore patient-specific outcomes, standardized intervention protocols, long-term efficacy, and safety across diverse populations.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.008 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".