Characteristics of the Voice Handicap Index for Patients With Unilateral Vocal Fold Paralysis Who Underwent Arytenoid Adduction

2020 ◽  
Vol 34 (4) ◽  
pp. 649.e1-649.e6 ◽  
Author(s):  
Kenichi Watanabe ◽  
Takeshi Sato ◽  
Yohei Honkura ◽  
Ai Kawamoto-Hirano ◽  
Kazutaka Kashima ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Voice Handicap Index ◽  
Unilateral Vocal Fold Paralysis ◽  
Arytenoid Adduction ◽  
The Voice

Novel Approach of Medialization Thyroplasty with Arytenoid Adduction Performed under General Anesthesia with a Laryngeal Mask

2011 ◽  
Vol 146 (2) ◽  
pp. 266-271 ◽  
Author(s):  
Nicholas W. Stow ◽  
Jennifer W. Lee ◽  
Ian E. Cole
Keyword(s):  
Vocal Fold ◽  
Case Series ◽  
Vocal Fold Paralysis ◽  
Laryngeal Mask ◽  
Unilateral Vocal Fold Paralysis ◽  
Maximum Phonation Time ◽  
Arytenoid Adduction ◽  
Medialization Thyroplasty ◽  
The Voice

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.

scholarly journals Modified Arytenoid Adduction Operation for the Treatment of Unilateral Vocal Fold Paralysis

ORL ◽  
2021 ◽  
pp. 1-6
Author(s):  
Chao Liu ◽  
Yuanzheng Qiu ◽  
Xin Zhang ◽  
Yong Liu ◽  
Guo Li ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
Thyroid Cartilage ◽  
Vocal Fold Paralysis ◽  
Subjective Perception ◽  
Unilateral Vocal Fold Paralysis ◽  
Mean Values ◽  
Arytenoid Adduction ◽  
The Voice

<b><i>Introduction:</i></b> Unilateral vocal fold paralysis (UVFP) was a relative common glottic insufficiency disease; however, a completely satisfactory treatment of UVFP was elusive. This study was aimed to evaluate the surgical efficacy of modified arytenoid adduction with fenestration of the thyroid cartilage in the management of patients with UVFP, including voice and aspiration outcomes, and to summarize the postoperative complications. <b><i>Methods:</i></b> A retrospective analysis was performed on a total of 21 patients who underwent modified arytenoid adduction operation with fenestration of the thyroid cartilage for UVFP from July 2012 to June 2017. The scores of Grade, Roughness, Breathiness, Asthenia, Strain scale (GRBAS), voice self-satisfaction, dynamic laryngoscopy and the voice acoustic data (fundamental frequency [F0], fundamental frequency perturbation [jitter], loudness, amplitude perturbation [shimmer], and maximal phonatory time [MPT], etc.) were statistically analyzed preoperatively and 3–6 months postoperatively. The occurrence of postoperative complications was also summarized. <b><i>Results:</i></b> The voice subjective perception of 21 patients was significantly improved after operation. The rate of voice self-satisfaction was 90.5%. The mean values of voice acoustics parameters were significantly improved. The MPT was significantly longer (<i>p</i> &#x3c; 0.001), and the ratings of postoperative aspiration were significantly decreased compared with the preoperation. Among the 21 patients, 15 cases had sense of laryngeal obstruction, 8 cases had of 1–2° laryngemphraxis (recovered after 10–15 days). There were 2 cases of laryngeal stridor, 1 case of incision infection, 1 case of pharyngeal fistula, and 1 case of falsetto (corrected by voice training). No patient had laryngeal hematoma, neck hematoma, or laryngospasm. <b><i>Conclusion:</i></b> The modified arytenoid adduction operation with fenestration of the thyroid cartilage can significantly improve the vocal function of patients with UVFP and effectively reduce the aspiration, with fewer postoperative complications, less trauma, and more convenient advantages.

Predicting the Outcome of Unilateral Vocal Fold Paralysis: A Multivariate Discriminating Model Including Grade of Dysphonia, Jitter, Shimmer, and Voice Handicap Index-10

2019 ◽  
Vol 128 (5) ◽  
pp. 447-452 ◽  
Author(s):  
Andrea Lovato ◽  
Maria Rosaria Barillari ◽  
Luciano Giacomelli ◽  
Lisa Gamberini ◽  
Cosimo de Filippis
Keyword(s):  
Vocal Fold ◽  
Speech Therapy ◽  
Univariate Analysis ◽  
Nearest Neighbors ◽  
Vocal Fold Paralysis ◽  
Voice Handicap Index ◽  
Misclassification Rate ◽  
Unilateral Vocal Fold Paralysis ◽  
K Nearest Neighbors ◽  
Motion Recovery

Objectives: The aim of this study was to investigate if any clinical and phoniatric characteristics or quality-of-life measures could predict the outcome of unilateral vocal fold paralysis (UVFP) initially managed with speech therapy. Methods: Forty-six patients with UVFP were evaluated using laryngostroboscopy, the GIRBAS (grade, instability, roughness, breathiness, asthenia, and strain) scale, acoustic analysis, and the Voice Handicap Index-10 (VHI-10) questionnaire. Treatment was speech therapy according to a 3-phase protocol. The main outcome measure was incomplete vocal fold mobility 12 months after symptom onset. Univariate and multivariate modeling ( k-nearest neighbors model) were applied. Results: Fifteen patients had incomplete motion recovery 12 months after the onset of UVFP. On univariate analysis, time to diagnosis (0.01), global grade of dysphonia (0.018), jitter (0.01), shimmer (0.012), and VHI-10 score (0.006) were associated with the outcome of vocal fold paralysis. Using a k-nearest neighbors multivariate discriminating model, the best discrimination of UVFP outcome was achieved with 4 parameters: global grade of dysphonia 2 or 3, jitter > 2.46%, shimmer > 6.97%, and VHI-10 score > 13. The model’s misclassification rate for incomplete motion recovery was only 6%. The model showed sensitivity of 93% and specificity of 74%. Conclusions: Delayed diagnosis and speech therapy was associated with negative outcomes. Higher grade of dysphonia, jitter, shimmer, and VHI-10 score on initial phoniatric assessment may help clinicians in predicting the outcomes of UVFP patients.

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

2021 ◽  
pp. 019459982110565
Author(s):  
Matthew R. Hoffman ◽  
Beau Vandiver ◽  
Natalie Derise ◽  
Edie R. Hapner ◽  
Glen Leverson ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Vocal Fold ◽  
Assessment Tool ◽  
Upper Airway ◽  
Severity Index ◽  
Vocal Fold Paralysis ◽  
Voice Handicap Index ◽  
Unilateral Vocal Fold Paralysis ◽  
Function Index ◽  
Patient Reported

Objective Patients with unilateral vocal fold paralysis commonly report dysphonia and dysphagia. Dyspnea also occurs, with studies on treatment-related change producing mixed results. Studies including patient-reported outcomes have focused on single-question global scales. The Dyspnea Index (DI) includes 10 questions, is specific to upper airway–related dyspnea, and may better capture these patients’ symptoms. We evaluated change in DI after treatment. Study Design Retrospective review. Setting Academic medical center. Methods Forty-three patients with unilateral vocal fold paralysis underwent injection augmentation (n = 25) or framework surgery (n = 18). DI was recorded preprocedure, 2 to 4 weeks afterward, and at approximately 3 months afterward in 19 patients. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 were also recorded. Change in parameters and correlations were assessed. Obesity, cardiac disease, pulmonary disease, and procedure (injection vs framework surgery) were evaluated for effect on DI. Results Twenty-four patients had an abnormal baseline DI (>10). DI decreased from 14.9 ± 13.8 to 6.5 ± 9.3 after treatment ( P < .001; 95% CI, 4.7-12.1). Twenty-eight scores decreased, 9 remained unchanged, and 6 increased. Change in DI was influenced by the presence of cardiac disease. Decreased DI persisted at 3-month follow-up. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 scores decreased and were correlated with change in DI. Conclusion Upper airway–related dyspnea is common in unilateral vocal fold paralysis, occurring in half of this cohort. Correcting glottic insufficiency may alleviate symptoms. Treatment decision making should consider postprocedural change in dyspnea, especially in patients for whom dyspnea is a motivating factor for seeking treatment.

Analysis of Pitch Range After Arytenoid Adduction by Fenestration Approach Combined With Type I Thyroplasty for Unilateral Vocal Fold Paralysis

2012 ◽  
Vol 26 (6) ◽  
pp. 792-796 ◽  
Author(s):  
Ryoji Tokashiki ◽  
Hiroyuki Hiramatsu ◽  
Eriko Shinada ◽  
Ray Motohashi ◽  
Masaski Nomoto ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Type I ◽  
Unilateral Vocal Fold Paralysis ◽  
Pitch Range ◽  
Arytenoid Adduction ◽  
Type I Thyroplasty

Arytenoid asymmetry: Is it the most predictive parameter for arytenoid adduction in unilateral vocal fold paralysis?

2021 ◽  
pp. 1-9
Author(s):  
J R Menon ◽  
A S Mathew ◽  
S Nath
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Arytenoid Adduction ◽  
Operative Planning ◽  
Group 2 ◽  
Retrospective Comparative Study ◽  
Two Parameters ◽  
Vertical Level

Abstract Objective The aim of this study was to establish arytenoid asymmetry as a pre-operative predictive parameter for arytenoid adduction surgery in unilateral vocal fold paralysis and thereafter identify the most predictive parameter for arytenoid adduction among the established parameters. Methods A retrospective comparative study was undertaken. The ‘arytenoid asymmetry angle’ formed between skewed ‘glottic’ and ‘interarytenoid’ axes (traced along the plane of closure of the membranous and cartilaginous glottis, respectively) was quantified in pre-operative laryngoscopic images of 85 adults with unilateral vocal fold paralysis who underwent either type 1 thyroplasty (group 1) or type 1 thyroplasty with arytenoid adduction (group 2). The need for arytenoid adduction was determined intra-operatively based on subjective voice improvement and laryngoscopic results. Results Arytenoid asymmetry (p < 0.0001), posterior phonatory gap (p = 0.001) and vertical level difference (p = 0.004) were significantly greater in group 2 (descending order of parameters). Arytenoid asymmetry angle showed a significant positive correlation with the latter two parameters. Conclusion Arytenoid asymmetry is the most predictive parameter for arytenoid adduction. An arytenoid asymmetry angle of more than or equal to 33.9⁰ is an indication for arytenoid adduction. This aids in pre-operative planning of arytenoid adduction.

Maximum vocal intensity as a primary outcome measure in unilateral vocal fold paralysis patients

2020 ◽  
pp. 1-9
Author(s):  
S F Johari ◽  
M Azman ◽  
A S Mohamed ◽  
M M Baki
Keyword(s):  
Vocal Fold ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Vocal Fold Paralysis ◽  
Voice Handicap Index ◽  
Injection Laryngoplasty ◽  
Unilateral Vocal Fold Paralysis ◽  
Post Intervention ◽  
Surgical Interventions ◽  
Vocal Intensity

Abstract Objective To evaluate voice intensity as the primary outcome measurement when treating unilateral vocal fold paralysis patients. Methods This prospective observational study comprised 34 newly diagnosed unilateral vocal fold paralysis patients undergoing surgical interventions: injection laryngoplasty or medialisation thyroplasty. Voice assessments, including maximum vocal intensity and other acoustic parameters, were performed at baseline and at one and three months post-intervention. Maximum vocal intensity was also repeated within two weeks before any surgical interventions were performed. The results were compared between different time points and between the two intervention groups. Results Maximum vocal intensity showed high internal consistency. Statistically significant improvements were seen in maximum vocal intensity, Voice Handicap Index-10 and other acoustic analyses at one and three months post-intervention. A significant moderate negative correlation was demonstrated between maximum vocal intensity and Voice Handicap Index-10, shimmer and jitter. There were no significant differences in voice outcomes between injection laryngoplasty and medialisation thyroplasty patients at any time point. Conclusion Maximum vocal intensity can be applied as a treatment outcome measure in unilateral vocal fold paralysis patients; it can demonstrate the effectiveness of treatment and moderately correlates with self-reported outcome measures.

Sign in / Sign up

Export Citation Format

Share Document