The vocal folds can atrophy, or lose muscle bulk and tone, due to a vocal fold paralysis or simply as a process of aging. With vocal fold atrophy, the vocal fold may not close completely, leading to a weak, hoarse voice.

All vocal fold augmentation procedures are undertaken to improve the closure of the vocal folds, which increases the strength of the voice and can improve swallowing function.

Some patients may benefit from temporary augmentation of the vocal folds, when the weakness is felt to be transient, or if the patient wants to undergo a trial augmentation before undergoing a permanent procedure.

In these cases, your doctor may inject the vocal fold with Cymetra or Gelfoam. Both of these materials are reabsorbed into the body over time. Cymetra is reabsorbed by the body usually in two to six months. Gelfoam is usually reabsorbed by the body in two to three months. 

Augmentation with Cymetra or Gelfoam can be completed in the office. In this case, local anesthetic is applied to a small area of skin on the neck, and a small amount is injected into the throat to suppress the cough during the procedure. The vocal folds are visualized using a flexible endoscope passed through one nostril, while the laryngologist uses a small needle to inject the material into the vocal fold.

Injections of Cymetra and Gelfoam can also be completed under general anesthesia in the OR. In this case, the injection may be made through a laryngoscope placed in the mouth.

Augmentation Procedure Instructions

The day of your in-office procedure, you may eat and drink normally. You can drive yourself to and from the appointment.

You should not eat or drink for two hours following the procedure.

You may talk normally after the procedure. You may notice a slight increase in hoarseness initially, with the best vocal quality being achieved over several days.

This article is intended as a resource for patients receiving their voice care at Duke Voice Care Center. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.