A critical care nurse is among the first patients to receive an experimental treatment for voice disorders involving injections of platelet-rich plasma (PRP) directly into the vocal cords. The treatment, currently being trialed at Guy’s Hospital in London, aims to address dysphonia – difficulty speaking – caused by vocal fold scarring, atrophy, sulcus, or inflammation.
David, 45, experienced voice problems exacerbated by the use of face masks during the COVID-19 pandemic. He described a sensation of his voice suddenly stopping mid-sentence, as if obstructed. He was subsequently referred to the ENT Clinic at Guy’s Hospital, where he became a candidate for the PRP injection trial.
The procedure itself involves extracting plasma from the patient’s own blood and then injecting it into the vocal folds. While PRP injections have been used for some time in orthopedic medicine to aid in the healing of tendons and ligaments, its application to vocal fold disorders is a relatively new approach.
Shiying Hey, the consultant leading the trial, reports positive initial results. “It’s incredibly exciting to be able to offer this treatment,” she says. “It is also cheaper than the current treatments as we use the patient’s own blood and it can be longer lasting as the PRP encourages the vocal cords to regenerate and accelerates the healing process.” So far, the team has treated ten patients, with all reporting improvements in their voice quality.
How PRP Works: Harnessing the Body’s Healing Potential
Platelet-rich plasma is a concentration of platelets and associated growth factors derived from a patient’s own blood. Platelets are key components of blood that play a crucial role in initiating the healing process. They release growth factors that stimulate tissue repair and regeneration. The idea behind using PRP in vocal fold disorders is to leverage these natural healing properties to address structural and functional issues within the vocal cords.
In the context of vocal fold disorders, PRP aims to address several underlying problems. For vocal fold scarring, the growth factors in PRP may help remodel the scar tissue, improving its flexibility and reducing its impact on vocal fold vibration. In cases of atrophy (thinning) of the vocal folds, PRP could potentially stimulate the growth of new tissue, increasing vocal fold mass and improving vocal function. Similarly, for sulcus vocal folds – characterized by grooves or indentations – PRP may promote tissue filling and smoothing. Finally, in inflammatory conditions, PRP’s anti-inflammatory properties could help reduce swelling and improve vocal fold mobility.
Current Treatment Options and the Need for Innovation
Traditionally, treatment options for vocal fold disorders have been limited. Voice therapy is often the first line of defense, teaching patients techniques to optimize their vocal production. However, therapy may not be sufficient for all cases, particularly those involving significant structural damage. Surgical interventions, such as thyroplasty (altering the position of the thyroid cartilage) or vocal fold injection with substances like fat or hyaluronic acid, are sometimes necessary, but these carry risks and may not always provide lasting results.
The appeal of PRP lies in its potential to offer a less invasive and more natural approach to vocal fold repair. By utilizing the patient’s own blood, the risk of allergic reaction or immune rejection is minimized. The regenerative properties of PRP could lead to more durable improvements in vocal function compared to some existing treatments.
Research Supports PRP’s Potential
Recent research, including a study published in Eur Arch Otorhinolaryngol in July 2024, supports the feasibility and potential benefits of PRP injections for benign vocal pathologies. The study, with a PMID of 39014252, evaluated 75 PRP injections administered to 48 patients with dysphonia caused by vocal fold scar, atrophy, sulcus, and inflammatory lesions. Researchers found significant improvements in several vocal parameters, including the Voice Handicap Index-10 (VHI-10), Vocal Fatigue Index (VFI), maximum phonation time (MPT), and GRBAS scale (a perceptual assessment of voice quality).
The study also reported a high patient satisfaction rate, with 72.3% of patients rating their improvement at 7 or above on a Likert scale, and 95.7% stating they would consider a future PRP injection. Importantly, even patients receiving a single PRP injection demonstrated sustained improvements over a six-month follow-up period.
A retrospective analysis published on ScienceDirect also indicates promising efficacy and safety of PRP injections for vocal fold scars and presbylaryngis treatment, noting significant improvements in perceptual voice analysis and subjective assessments. However, the authors emphasize the need for larger, controlled studies to confirm these findings and refine PRP therapy protocols.
Looking Ahead: Clinical Trials and Future Applications
Ongoing clinical trials, such as the one registered on ClinicalTrials.gov (NCT07300800), are further investigating the efficacy of PRP injections for voice recovery after benign vocal fold injuries. These trials aim to provide more robust evidence to support the widespread adoption of PRP as a treatment option.
While the initial results are encouraging, it’s important to note that PRP is not a one-size-fits-all solution. The optimal PRP concentration, injection technique, and patient selection criteria are still being investigated. Further research is needed to determine which patients are most likely to benefit from this treatment and to optimize the protocol for maximizing outcomes. However, the early data suggests that PRP injections hold significant promise as a safe and effective treatment option for a range of vocal fold disorders, offering a potential alternative to more invasive procedures and improving the quality of life for individuals struggling with voice problems.
