Special Topics 3 - Platelet-Rich Plasma for Vocal Fold Scar: A Preliminary Report of Concept​

Introduction. Vocal fold atrophy and scar can lead to loss of normal superficial lamina propria, negatively affecting the vibratory function of the vocal fold. These changes can lead to dysphonia, vocal fatigue, decreased volume, and altered pitch. Treatment options for these conditions are limited. Platelet-rich plasma (PRP) consists of platelets, growth factors, and cytokines derived from the patient’s own blood and is believed to activate tissue regeneration. The purpose of this study was to review the technical aspects of collecting PRP and injecting it into the vocal fold injection − based on our initial experience with this procedure. Case: A patient with vocal fold scar was identified and enrolled in an ongoing prospective clinical trial study of a series of 4 monthly subepithelial vocal fold PRP injections, which was temporarily halted due to the COVID-19 pandemic. Patient underwent a single injection of autologous PRP into the left vocal fold. There were no adverse events during the study period. Subjective improvement in voice was noted at 1 month after injection with subsequent return to baseline over the next 4 months. Videostroboscopy performed on postinjection day 1 and day 7 and demonstrated no concerning exam changes. Compared to the preinjection baseline, the patient-reported voice-handicap index-10 (VHI-10) and voice catastrophization index were similar at 4 months following injection (20 to 20 and 4 to 3, respectively). Independent perceptual analysis of voice showed improvement at 4 months postinjection, compared to baseline consensus auditory-perceptual evaluation of voice 60 to 44. Conclusions. This preliminary report was part of a prospective trial investigating the use of PRP to treat vocal fold atrophy and scar. This work highlights the technical considerations for injecting PRP into the vocal fold. Planned prospective enrollment in this study will help to validate the safety and efficacy of PRP injections.

Financial Disclosure: Dr. Johns has no financial relationships to disclose.


Non-Financial Disclosure: ​Dr. Johns has no non-financial relationships to disclose.


Michael M. Johns III, M.D.
Director, USC Voice Center

Professor, Caruso Department of Otolaryngology – Head and Neck Surgery
University of Southern California


As director of the USC Voice Center, Michael Johns III, MD is committed to improving the quality of life for individuals with voice, swallowing and airway disorders. He strives to achieve this through a true interdisciplinary approach to promoting health, preventing and curing disease, advancing biomedical research and educating those around him. He received his undergraduate degree from the University of Virginia, and then went on to pursue his passion for medicine. He graduated medical school from Johns Hopkins University and then pursued training in Otolaryngology – Head and Neck Surgery at the University of Michigan. While there, he did an NIH-funded research year and became interested in voice, swallowing and airway disorders, which led him to pursue specialty fellowship training at the Vanderbilt Voice Center. He founded the Emory Voice Center with speech language pathologist Edie Hapner, PhD in Atlanta, Georgia, which was amongst the first interdisciplinary voice centers in United States. Twelve years later, he was recruited to the University of Southern California to form the USC Voice Center and bring an interdisciplinary model of care to Southern California. Dr. Johns embraces a caring, patient-centered approach with his patients. At the USC Voice Center, his patients can count on a coordinated, cohesive and unique experience delivered by a team of voice and swallowing experts that strive to optimize outcomes and satisfaction.