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Originally published September 3, 2026
Last updated September 3, 2026
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A patient with persistent hoarse voice or dysphagia often presents a diagnostic puzzle. While reflux and common laryngitis are frequent culprits, a subset of patients present with conditions that are notoriously difficult to manage: vocal fold scar, atrophy, paralysis and recurrent respiratory papillomatosis (RRP). Keck Medicine of USC is pioneering the use of novel, minimally invasive and regenerative therapies for these challenging disorders.
At the heart of these efforts is the USC Voice Center, part of Keck Medicine and the USC Caruso Department of Otolaryngology – Head and Neck Surgery. Elizabeth A. Shuman, MD, a board-certified otolaryngologist and fellowship-trained laryngologist at the center, explains that the unique structure of the center allows for the integration of medical, surgical and behavioral therapies.
With a background in professional singing, Shuman deeply understands the important role the voice has in someone’s identity and sometimes even their livelihood. “Speaking, singing, swallowing and breathing are all part of the human experience and things we take for granted every day,” she says. “What we have here at the USC Voice Center is quite special. We are constantly running clinical trials, experimenting and trying different techniques and strategies to best help our patients.” Laryngologists at the USC Voice Center see patients alongside specialized speech-language pathologists to refine and expedite care.
The center’s multidisciplinary approach is critical when tackling structural disorders of the vocal folds, such as atrophy, which can be due to aging or scarring stemming from trauma or surgical complications. The pathophysiology of these conditions lies in the disruption of the vocal fold’s layered microstructure, specifically the superficial lamina propria. Once this gelatinous tissue is lost, it does not regenerate, leading to impaired mucosal wave propagation, increased stiffness and persistent dysphonia. Historically, treatment options have been limited.
To address this, the USC Voice Center has turned to the principles of regenerative medicine. One of their standout innovations is the use of autologous platelet-rich plasma (PRP) injections, borrowed from the fields of orthopedics and facial plastics. Shuman describes this treatment as a key advancement for patients with vocal fold scar refractory to voice therapy. In a prospective clinical trial coauthored by Shuman and colleagues from the USC Voice Center, serial PRP injections demonstrated clinically meaningful improvements in patient-reported voice handicap and perceptual voice quality. The mechanism is thought to involve mechanical expansion of the vocal fold cover to disrupt scar adhesions, while the growth factors promote an antifibrotic and regenerative healing environment.
Similarly, for age-related vocal fold atrophy or paralysis (glottal insufficiency), the center is investigating an innovative, off-the-shelf filler material comprising collagens, proteins and growth factors found in adipose tissue. This product is a decellularized allograft adipose matrix — essentially the biological scaffolding of human fat tissue — that is sometimes used in facial plastics to fill large defects. “It signals to your own body to regenerate your fat into the scaffolding,” Shuman notes. Unlike traditional fillers that are reabsorbed, because this particular filler material stimulates adipogenesis, it potentially offers a more durable and natural correction for closure deficits. The USC Voice Center recently led a clinical trial demonstrating its safety and efficacy in treating vocal fold paralysis.
Perhaps the most transformative recent development is the FDA approval of Papzimeos (zopapogene imadenovec-drba) for the treatment of recurrent respiratory papillomatosis (RRP). Caused by chronic infection with HPV types 6 and 11, RRP leads to recurrent benign tumors of the respiratory tract and is a significant cause of voice and airway morbidity. Until 2025, there were no approved medical therapies to prevent recurrence, meaning patients faced repeated surgical debulking. Shuman notes that the USC Voice Center is now offering this new injectable immunotherapy.
Papzimeos is a non-replicating adenoviral vector-based immunotherapy designed to stimulate an immune response against HPV 6/11-infected cells. In a landmark trial, 51.4% of patients who required three or more surgeries per year achieved a complete response (defined as no need for surgical intervention for 12 months after treatment). This represents a paradigm shift from repeated surgery alone to integrating an immunologically targeted approach in which surgery plus Papzimeos results in best outcomes.
Shuman emphasizes that for any patient with hoarseness persisting longer than four weeks, early and direct visualization of the vocal folds is critical before empirically treating for reflux or prescribing steroids. As Shuman notes, initiating therapy without visual examination can delay diagnosis and compromise vocal outcomes.
Many of the advanced, tissue-sparing techniques available at the USC Voice Center, including office-based awake laser treatments for polyps and delicate microflap biopsies, are designed to preserve as much normal tissue as possible. By leveraging these advanced, often office-based, procedures, the USC Voice Center is not just restoring voice but also protecting the swallowing and airway function that defines a patient’s quality of life. For patients with complex, non-resolving voice and swallowing disorders, a referral to the USC Voice Center provides access to these promising, leading-edge therapies.
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