Safety and efficacy of carboxymethylcellulose in the treatment of glottic insufficiency

Laryngoscope. 2012 Feb;122(2):322-6. doi: 10.1002/lary.21930. Epub 2012 Jan 18.


Objectives/hypothesis: No studies to date have examined the clinical safety and efficacy of carboxymethylcellulose (CMC) for vocal fold injection. The current study investigates the voice outcomes and complications of CMC injection.

Study design: Retrospective review.

Methods: All patients who underwent CMC injection from three independent sites in a 1-year period were reviewed. Voice outcomes in the form of voice handicap index-10 (VHI-10) and complications from injection were recorded.

Results: Seventy-eight patients with VHI-10 results from 1 to 8 weeks after CMC injection were evaluated. Thirty-eight patients were treated for vocal fold immobility, and 15 patients underwent treatment for hypomobility, 15 for vocal fold atrophy, seven for scar/sulcus, one for previous laryngeal fracture, one for functional dysphonia, and one for persistent granuloma. In 60 patients with available VHI-10 data, overall improvement in voice was seen. There was a mean decrease in VHI-10 of 7.48 (26.4 to 18.9, P < .05), correlating to a 19.9% decrease. Forty-five patients (75%) showed a decrease in VHI-10, nine (15%) showed an increase, and six (10%) showed no change. Statistically significant differences were seen for patients with immobility (decrease of 8.6, or 31%) and hypomobility (decrease of 10.7, or 37.8%). There were no complications of vocal fold stiffness, inflammatory reaction, or scar in the 78 patients during the total follow-up period.

Conclusions: CMC is a viable, safe, and efficacious material for the temporary treatment of glottic insufficiency in vocal fold immobility and hypomobility, with minimal risk of permanent adverse voice outcomes.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cellulase / administration & dosage*
  • Female
  • Follow-Up Studies
  • Glottis / physiopathology*
  • Humans
  • Injections
  • Laryngeal Diseases / complications
  • Laryngeal Diseases / physiopathology
  • Laryngeal Diseases / therapy*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome
  • Vocal Cord Paralysis / etiology
  • Vocal Cord Paralysis / physiopathology
  • Vocal Cord Paralysis / therapy*
  • Vocal Cords
  • Voice
  • Voice Quality*
  • Young Adult


  • Cellulase
  • carboxymethylcellulase