Prospective Outcomes After Serial Platelet-Rich Plasma (PRP) Injection in Vocal Fold Scar and Sulcus

Objective: Vocal fold scar and sulcus pose significant treatment challenges with no current optimal treatment. Platelet-rich plasma (PRP), an autologous concentration of growth factors, holds promise for regenerating the superficial laminapropria. This study aims to evaluate the potential benefits of serial PRP injections on mucosal wave restoration and vocalfunction. Methods: In a prospective clinical trial across two institutions, patients with vocal fold scar underwent four serial PRPinjections, one month apart. Blinded independent laryngologists and expert listeners used pretreatment and one-month post-fourth injection videostroboscopy and CAPE-V assessments to evaluate mucosal wave and voice quality changes, respectively.Additionally, patient reported outcome measures (PROMs) were evaluated. Results: In the study, 15 patients received 55 PRP injections without adverse effects. Eight patients (53.3%) had mild,three patients (20%) had moderate, and four patients (26.7%) had severe scar.There was an average reduction of 8.7 points in post-treatment VHI-10 scores (p=0.007). The raters observed animprovement in post-treatment voice in 73.4% of cases, and CAPE-V scores showed a reduction of 18.8 points on average(p=0.036). The videostroboscopic VALI ratings showed an improvement in mucosal wave rating from 2.0 to 4.0. On average,the raters perceived the post-PRP exams to be better in 56.7% of cases. Conclusions: PRP has been validated as a safe autologous option for treatment of vocal fold scar. While results for muco-sal wave and voice quality varied, there was a consistent improvement in PROMs