Office-Based Vocal Fold Injections

Who is a candidate for vocal fold injections?


Individuals with

  • Shrinking vocal folds due to aging (atrophy)
  • Vocal cord paresis   
  • Vocal cord paralysis
  • Granulomas of the vocal folds (ulcerous masses that affect voice production)
  • Reinke’s Edema (large vocal folds in female smokers that results in a low pitch and rough voice quality)
  • Spasmodic dysphonia
  • Laryngeal tremor
  • Vocal fold nodules

Why are vocal fold injections performed?


An office-based vocal fold injection is performed to deliver a filler such as a gel or a paste into one or both vocal folds to improve voice production and/or swallowing function.  It is possible also to inject a medicine (drug) into one or both vocal folds to improve voice. An example is the injection of Botulinum Toxin (BOTOX-tm) into one or both vocal folds in individuals with spasmodic dysphonia or laryngeal tremor.


What is involved in vocal fold injections?


Vocal fold injection usually takes less than thirty minutes and can be incorporated into a standard office visit. It can also be scheduled as a separate short procedure. The vocal fold can be accressed through the mouth, through the nose or through the skin of the front of the neck. The procedure is performed in the office without sedation. Patients can drive themselves home and wear standard street clothing.


Patients sit in a standard examination chair in the Otolaryngolgy clinic examination room. Topical anesthesia (lidocaine) and decongestion (Afrin) are applied to one of the nasal passages. A small amount of lidocaine liquid is swallowed to help numb the throat and esophagus. A flexible endoscope (camera) is then passed through one of the nasal passages into the throat and down into the esophagus. Air is puffed into the esophagus and stomach which can cause some burping. Individuals can experience discomfort in the nose, the throat and the stomach which stops when the endoscope is removed. Some individuals may feel lightheaded. The camera is then advanced to the end of the esophagus and into the stomach. Video images are taken during the examination to review with the patient at the end of the visit.

What can I expect after vocal fold injections?

Patients will have a numb throat for 45 minutes to an hour after the procedure. They should not have anything to eat or drink for one hour after the procedure to make sure they don’t aspirate (have food or liquid go down "the wrong pipe"). The nose can sometimes be a little sore after the procedure. Taking Tylenol should be sufficient to control any discomfort related to this.

Why should I have vocal fold injections at UW Health?

The Otolaryngologists have specialized training in disorders of the larynx, trachea, and esophagus. These specialists (Laryngologists) have extensive experience with TNE and other office procedures and use multiple relaxation techniques to make the procedure as fast, effective and comfortable as possible.


Having these procedures in the office permits the Laryngologists to obtain important information about the esophaus in a safe and effective way. Importantly performing TNE prevents evaluations with sedation. Sedation can carry additional risk to the patient, as well as time off of work and the need for others to devote time to taking care of them after the procedure.