Precise Vocal Cord Medialization Using an Adjustable Laryngeal Implant: A Preliminary Study

1993 ◽  
Vol 109 (6) ◽  
pp. 1014-1019 ◽  
Author(s):  
Martin Desrosiers ◽  
Christian Ahmarani ◽  
Maurice Bettez
Keyword(s):  
Vocal Cord ◽  
Vocal Fold ◽  
Vocal Cord Paralysis ◽  
Substantial Improvement ◽  
Vocal Function ◽  
Medialization Thyroplasty ◽  
Preliminary Study ◽  
Vocal Quality ◽  
Unilateral Vocal Cord Paralysis

Treatment of symptomatic unilateral vocal cord paralysis is most frequently surgical. Medialization of the vocal cord using Teflon injection has proved effective; however, studies have shown this technique to produce stiffness of the vocal fold with loss of the “mucosal wave” and concomitantly poor vocal function. As well, overcorrection may occur and is not reversible. Isshiki type 1 medialization thyroplasty has been shown to produce a substantial improvement In vocal quality, as well as preserve the mucosal wave. A number of problems encountered during the performance of isshiki type 1 thyroplasty has led us to modify the original technique. We have developed a new implant that allows for precise, easily adjustable control of vocal cord medialization. To evaluate the degree of vocal cord medialization afforded by this implant, larynges of fresh male and female cadavers were used as an experimental model. In both larynges, vocal cord medialization was shown to occur in a predictable fashion for the anterior, middle, and posterior segments, as well as In the functionally Important inter-arytenoid region. We believe the use of this implant in medialization thyroplasty will allow precise, atraumatic medialization of the paralyzed vocal cord. This greater control over positioning and ease of adjustment should contribute to enhanced vocal quality.

scholarly journals Glottal Function Index and GRBAS Scale of Patients Undergoing Vocal Cord Medialization: A Series of Five Patients

2013 ◽  
Vol 28 (2) ◽  
pp. 14-17
Author(s):  
Enrique C. Papa ◽  
Emmanuel S. Samson ◽  
Francisco A. Victoria
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Voice Quality ◽  
Silicone Implant ◽  
Subjective Symptoms ◽  
Medialization Thyroplasty ◽  
Function Index ◽  
Glottal Insufficiency ◽  
Unilateral Vocal Cord Paralysis

Objectives: Vocal cord paralysis or immobility is a debilitating condition that may result from neural injury or mechanical fixation of the vocal cord (VC).  When permanent, therapy is aimed at improving closure by modifying the position of the vocal cord. Whatever surgical intervention is chosen, pre - and post - operative voice evaluation is important. This study aimed to investigate the usefulness of the Glottal Function Index (GFI) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) Scale in the evaluation of treatment outcomes in patients with unilateral vocal cord paralysis (UVCP) who underwent medialization thyroplasty type 1 with a modified lock-in soft silicone implant. Methods: Study Design: Descriptive Case Series Setting: Tertiary Government Hospital Patients: Five Results:  Five patients (3 females, 2 males) consulting due to hoarseness underwent rigid endoscopy.  Four (2 right, 2 left) had unilateral paramedian VC paralysis while one had bilateral paresis with bowing of the left vocal cord.  One of those with left VC paralysis was diagnosed as idiopathic; the four were iatrogenic (3 from thyroid surgery, 1 from multiple surgical procedures). All patients underwent medialization thyroplasty type 1 using locked-in soft silicone implant. The GFI and GRBAS scale were utilized for pre-operative and post-operative perceptual evaluation of voice.  The GFI showed severe glottic insufficiency among all five patients prior to surgery with improvement of subjective symptoms one day and one week post-surgery in four patients. Likewise, the Hirano GRBAS scale showed improvement of voice quality and correlated well with the improvement of the patient’s subjective symptoms from the GFI scores. However, case 5 with bilateral vocal cord paresis, showed no improvement of voice quality despite recovery from subjective symptoms. Conclusion: For glottal insufficiency, perceptual voice evaluation using self-administered GFI and GRBAS scale assessment are important parameters in determining quality of life among patients with glottal insufficiency undergoing medialization laryngoplasty. Keywords: Hoarseness, unilateral vocal cord paralysis, medialization thyroplasty, Glottal Function Index, Hirano GRBAS Score

scholarly journals Voice outcome after type-1 thyroplasty for unilateral vocal cord paralysis: our experience at tertiary care hospital

2020 ◽  
Vol 6 (8) ◽  
pp. 1449
Author(s):  
Ihsan Ali ◽  
Omar Mohammad Shafi ◽  
Faheem Khalid ◽  
Owais Makhdoomi
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Tertiary Care ◽  
Objective Analysis ◽  
Silicone Implants ◽  
Care Hospital ◽  
Maximum Phonation Time ◽  
Medialization Thyroplasty ◽  
Unilateral Vocal Cord Paralysis

<p class="abstract"><strong>Background:</strong> Vocal cord paralysis is a clinical sign caused by paralysis of intrinsic muscles of larynx due to dysfunction of recurrent laryngeal nerve or injury to the vagus nerve. One of the common and effective methods of medialization is by using silicone implants. This study was aimed at prospectively assessing and analysing the vocal outcomes and quality of life of patients in type 1 medialization thyroplasty using silicone implants.</p><p class="abstract"><strong>Methods:</strong> Prospective study of 18 months was done on 17 patients with unilateral vocal cord paralysis. Surgical procedure for the patients was standardized by using silicon implant to medialize the cord. The parameters used for the pre and post treatment objective analysis were stroboscopic analysis, psychoacoustic evaluation, maximum phonation time (MPT) and patient’s self-assessment.  </p><p class="abstract"><strong>Results:</strong> In our study all 17 patients with unilateral vocal cord paralysis who were subjected to vocal cord medialization using silicone implant showed a statistically highly significant improvement in all the parameters of assessment. The mean preoperative MPT was 7.260 and post-operative MPT showed significant improvement and was 17.428 seconds. mean preoperative GRBAS score was 11.695 and post-operative was 3.826. Similarly, pre op vocal handicap index was 31.173 which decreased significantly after the procedure was 7.695.</p><p class="abstract"><strong>Conclusions:</strong> In the present study, we obtained favourable results of medialization thyroplasty as expressed by objective analysis of voice including GRABS score and acoustic analysis as well as maximum phonation time apart from traditional voice recording.</p><p> </p>

To study voice quality before and after thyroplasty type 1 in patients with symptomatic unilateral vocal cord paralysis

2003 ◽  
Vol 24 (6) ◽  
pp. 361-365 ◽  
Author(s):  
Sridhara Suryanarayan Rao ◽  
Ashok Kumar Gupta ◽  
Meena Raghunathan ◽  
Sher Baj Singh Mann
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Voice Quality ◽  
Before And After ◽  
Unilateral Vocal Cord Paralysis

scholarly journals Efficacy of Arytenoidectomy after Suture Lateralisation Failure in Patients with Bilateral Vocal Cord Paralysis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Shinsuke Suzuki ◽  
Takechiyo Yamada
Keyword(s):  
Case Report ◽  
Vocal Cord ◽  
Mucous Membrane ◽  
Vocal Fold ◽  
Vocal Cord Paralysis ◽  
Vocal Fold Paralysis ◽  
Bilateral Vocal Cord Paralysis ◽  
Vocal Function ◽  
Case Methods ◽  
Bilateral Vocal Fold Paralysis

Background. Endolaryngeal suture lateralisation is an ideal operation for bilateral vocal fold paralysis. However, restenosis owing to breakage and slippage of suture can sometimes occur. In such a case, methods that are more effective in expanding the glottis, including arytenoidectomy, must be selected. Case Report. Herein, we report two female patients aged 86 and 54 years who presented with bilateral vocal cord paralysis and who had restenosis after suture lateralisation. Endoscopic partial arytenoidectomy was performed, and satisfactory outcomes were obtained. This method maintains the height of the arytenoid and preserves its sensation by leaving a part of the cartilage and mucous membrane. Conclusion. Endoscopic partial arytenoidectomy is effective for securing the airway while preserving vocal function and preventing aspiration. This technique is suitable for patients with restenosis after they have undergone endolaryngeal suture lateralisation.

scholarly journals An Investigation of Vocal Tract Characteristics for Acoustic Discrimination of Pathological Voices

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Jung-Won Lee ◽  
Hong-Goo Kang ◽  
Jeung-Yoon Choi ◽  
Young-Ik Son
Keyword(s):  
Vocal Cord ◽  
Vocal Fold ◽  
Vocal Tract ◽  
Vocal Cord Paralysis ◽  
Vocal Folds ◽  
Normal Subjects ◽  
Additional Information ◽  
Acoustic Discrimination ◽  
Improved Performance ◽  
Unilateral Vocal Cord Paralysis

This paper investigates the effectiveness of measures related to vocal tract characteristics in classifying normal and pathological speech. Unlike conventional approaches that mainly focus on features related to the vocal source, vocal tract characteristics are examined to determine if interaction effects between vocal folds and the vocal tract can be used to detect pathological speech. Especially, this paper examines features related to formant frequencies to see if vocal tract characteristics are affected by the nature of the vocal fold-related pathology. To test this hypothesis, stationary fragments of vowel /aa/ produced by 223 normal subjects, 472 vocal fold polyp subjects, and 195 unilateral vocal cord paralysis subjects are analyzed. Based on the acoustic-articulatory relationships, phonation for pathological subjects is found to be associated with measures correlated with a raised tongue body or an advanced tongue root. Vocal tract-related features are also found to be statistically significant from the Kruskal-Wallis test in distinguishing normal and pathological speech. Classification results demonstrate that combining the formant measurements with vocal fold-related features results in improved performance in differentiating vocal pathologies including vocal polyps and unilateral vocal cord paralysis, which suggests that measures related to vocal tract characteristics may provide additional information in diagnosing vocal disorders.

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