Managing voice impairment after injection laryngoplasty.

To date, there is a paucity of literature on the management of suboptimal voice outcomes after injection laryngoplasty. We present three cases of worsened voice quality and impaired mucosal waveform propagation on videostroboscopy after calcium hydroxylapatite (CaHA) injection. The first was found to have superficial deposits of CaHA in Reinke's space. The second case appeared to have overaugmentation of the vocal folds. The third case had atrophic vocal folds, and despite having a deep CaHA injection (within the thyroarytenoid muscles), the injected vocal folds had diminished mucosal waveform amplitude, which was likely because of poor pulmonary function. In summary, there can be multiple reasons for suboptimal voice outcomes after CaHA. Clinician awareness and intraoperative recognition of improper CaHA injection/overinjection can help prevent most negative outcomes.