Safety Profile in Hyaluronic Acid‐Based Vocal Fold Injection Augmentation

OBJECTIVE: The study's objective is to assess the safety profile and complication rates of hyaluronic acid-based vocal fold injection augmentation (VFIA), specifically evaluating inflammatory reactions, injection volume, and COVID-19 vaccination status. METHODS: A retrospective cohort study was conducted of 299 VFIA procedures performed using Restylane-L at a single academic institution. Medical charts were reviewed to collect patient demographics, injection details (approach, location, and volume), videolaryngostroboscopy exams, and post-injection outcomes, including complication rates and nature of inflammatory reactions. RESULTS: The overall complication rate was 4.0% (12/299), with inflammatory complications comprising 2.34% (7/299) of cases. Inflammatory symptoms developed a mean of 4.3 days after injection (median: 3 days; range: 12 h-10 days) and resolved in all cases with corticosteroid therapy. A statistically significant difference in injection volume was noted among groups (p = 0.037), although post hoc comparisons did not demonstrate significance. COVID-19 vaccination status was not associated with complication rates (p = 0.84). CONCLUSIONS: VFIA using HA-based material demonstrates a low rate of complications, and all inflammatory reactions resolved with medical management. Injection volume may play a role in complication risk, but further multi-site studies are needed. No association between COVID-19 vaccination and adverse outcomes was identified.