Efficacy of Posterior Pharyngeal Wall Injection for Velopharyngeal Dysfunction in Adults

Objective(s)Posterior pharyngeal wall (PPW) injection is often employed to treat velopharyngeal deficiency (VPD). We sought to analyze the impact of PPW injection on severity of dysphagia and dysphonia.MethodsRetrospective chart review was conducted of patients undergoing PPW injection from 2018 to 2023 at a tertiary laryngology center. Effects on Voice Handicap Index-10 (VHI-10), Eating Assessment Tool-10 (EAT-10), soft palate closure on modified barium swallow, and auditory-perceptual measures of hypernasality and audible nasal air emission were analyzed.Results67 PPW injections were performed in 29 patients (11 female). Mean age was 59.4 +/- 17.0 years. Etiologies were head and neck cancer (n = 23) and neurologic conditions (n = 6). 30 PPW injections were performed concurrent with intervention on the upper esophageal sphincter (25 dilations, 3 myotomies, 2 botulinum toxin injections), and 8 with a glottic procedure (6 vocal fold injections, 2 thyroplasties). Change scores were 3.87 (-6.85 to -0.89, p = .012) for VHI-10 and -3.00 (-4.75 to -1.25, p = 0.001) for EAT-10. These were statistically different from 0 for the whole cohort but not in the subset of patients undergoing concurrent voice and/or swallow surgery. Soft palate closure scores tended to be better (but not statistically significant) on MBS after PPW injection. Hypernasality and audible nasal air emission both improved after injection.ConclusionPPW injection appears to have a therapeutic effect on dysphagia/dysphonia in patients with VPD; however, many patients have multifactorial impairment. Additional study is needed to determine benefit of PPW when performed in conjunction with other procedures in this complex patient population.Level of EvidenceLevel 4 (Case series) Laryngoscope, 2024 In this article, we describe the impact of posterior pharyngeal wall (PPW) injection augmentation in adult patients with velopharyngeal deficiency (VPD) in term of its impact on subjective measures of dysphagia and dysphonia. Herein, we provide additional support for efficacy of this treatment while highlighting the complexity of this patient population, who often exhibit multifactorial deficiencies in speech and swallow.image