Pre and Post Operative Voice Analysis After Medialization Thyroplasty in Cases of Unilateral Vocal Fold Paralysis

Objective. To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture. Study Design. Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis. Setting. Tertiary referral teaching hospital in Sydney, Australia. Subjects. All patients had a unilateral vocal fold paralysis, with a large posterior glottic gap and vocal symptoms affecting their quality of life. Methods. Thirteen patients with a diagnosis of a unilateral vocal fold paralysis with a large posterior glottic gap, vocal symptoms, and total denervation of the vocal fold underwent medialization thyroplasty and arytenoid adduction suture. The surgery was performed in a novel method under a general anesthetic using a laryngeal mask and with direct intraoperative endoscopic feedback. Preoperative and postoperative measures of voice performance were compared, including acoustic analysis (fundamental frequency, speech intensity against quiet and loud background noise, speech rate) and aerodynamic assessment (airflow, maximum phonation time). Results. Medialization thyroplasty with arytenoid adduction suture significantly improved aerodynamic assessment and phonation duration for both male and female subjects overall. There were 2 of 13 treatment failures. Median follow-up time was 6 months. Conclusion. Preliminary results indicate that in selected patients with vocal fold paralysis, medialization thyroplasty with arytenoid adduction suture leads to significant improvements in objective voice measures. Longer follow-up data are required to further quantify the voice outcomes after this procedure.

Download Full-text

Evaluation and Treatment of the Unilateral Paralyzed Vocal Fold

Otolaryngology ◽

10.1177/019459989411100419 ◽

1994 ◽

Vol 111 (4) ◽

pp. 497-508 ◽

Cited By ~ 121

Author(s):

H. Bryan Neel ◽

Stephen G. Harner ◽

Michael S. Benninger ◽

Roger L. Crumley ◽

Charles N. Ford ◽

...

Keyword(s):

Physical Examination ◽

Vocal Fold ◽

State Of The Art ◽

Vocal Fold Paralysis ◽

Voice Therapy ◽

Unilateral Vocal Fold Paralysis ◽

Voice Analysis ◽

Multiple Modalities ◽

Inappropriate Treatment ◽

Laryngeal Reinnervation

The evaluation and treatment of patients with unilateral vocal fold paralysis have evolved as improvements in objective measurements of phonatory function and new modalities for treatment have developed. A thorough history, physical examination, subjective voice evaluation, objective voice analysis, and electromyography are used to make a diagnosis, determine the cause, and plan treatment. The goal of treatment of the patient with a unilateral vocal fold paralysis is to restore normal phonatory function without aspiration. Multiple modalities have developed to allow for restoration of nearly normal phonatory function, and these include voice therapy alone or in combination with injection medlalization, laryngoplastic phonosurgery, or laryngeal reinnervation. Otolaryngologists should be familiar with the incidence, cause, evaluation, and state-of-the-art treatment of unilateral vocal fold paralysis to optimize patient care and avoid suboptimal results often seen with antiquated or Inappropriate treatment.

Download Full-text