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>

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

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.

Medialization Laryngoplasty in the Elderly: Outcomes and Expectations

2017 ◽  
Vol 157 (4) ◽  
pp. 664-669 ◽  
Author(s):  
Andrew Jay Bowen ◽  
Tiffany L. Huang ◽  
Michael S. Benninger ◽  
Paul C. Bryson
Keyword(s):  
Elderly Patients ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Tertiary Care ◽  
Anticoagulation Therapy ◽  
Voice Handicap Index ◽  
Care Hospital ◽  
Disease Etiology ◽  
Chi Square Analysis ◽  
Medialization Laryngoplasty

Objective To describe the profile and outcomes of elderly patients undergoing medialization laryngoplasty for vocal cord paralysis. Study Design Case series with retrospective review. Setting Tertiary care hospital. Subjects and Methods Patients were included in the study if they were >65 years old at the time of medialization laryngoplasty between 2008 and 2015. Patient comorbidities, anticoagulation status, disease etiology, and physical examination findings were recorded with postoperative length of stay, complications, pre- and posttreatment voice outcomes with the Voice Handicap Index (at 6 weeks, 4 months, 8 months, and 1 year), and postprocedural interventions (revision injections, surgery, therapy). Results A total of 112 patients met the eligibility criteria. Iatrogenic injury to the recurrent laryngeal nerve (50%) was the most common etiology, followed by idiopathic (31%) causes. Sixty percent of patients were receiving long-term antiplatelet and/or anticoagulation therapy. All but 14 patients on aspirin therapy stopped their antiplatelet/anticoagulation therapy prior to surgery. Most patients were discharged on the day of surgery. Postprocedure Voice Handicap Index scores significantly improved ( P < .001) by 47%, 53%, 64%, and 57% at each of the 4 measured postprocedure dates, respectively. Two patients had major nonsurgical complications postoperatively requiring inpatient hospitalization. Chi-square analysis revealed no differences between intraoperative aspirin use, sex, or comorbidities and the incidence of complications ( P > .05). Conclusion The clinical profile and outcomes of our patients undergoing medialization laryngoplasty are comparable to those seen in younger cohorts. Medialization laryngoplasty is a safe and successful option for elderly patients with vocal cord paralysis and vocal handicap.

scholarly journals Prospective analysis of type I thyroplasty using gore-tex implant

2017 ◽  
Vol 3 (2) ◽  
pp. 276
Author(s):  
Sanjeev Mohanty ◽  
Sreenivas . ◽  
Vinay Raj T. ◽  
Devipriya . ◽  
Vinoth M.
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Vocal Cord Palsy ◽  
Post Treatment ◽  
Type I ◽  
Self Assessment ◽  
Maximum Phonation Time ◽  
Number Of Factors ◽  
Treatment Objective ◽  
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. There are several methods available surgically for the medialisation of the abducted vocal cord. One of the common effective modality is the Gore-Tex medialisation thyroplasty. The results depend on a number of factors including the surgical expertise and extrusion of the Gore –Tex implant. This study is aimed at analysis of all Gore-Tex medialisation thyroplasty done at our centre. Prospectively asses and analyze the vocal outcomes and quality of life of patients in type 1 medialisation thyroplasty using Gore-Tex implant.</p><p class="abstract"><strong>Methods:</strong> Prospective study of 48 months on 30 patients with unilateral vocal cord paralysis.  Surgical procedure for the patients was standardized by using Gore-Tex implant to medialize the cord. Video-Laryngoscopy at end of 1<sup>st</sup> month and stroboscopy &amp; voice analysis at end of 3<sup>rd</sup> month post treatment, the parameters used for the pre and post treatment objective analysis are a) stroboscopic analysis, b) psychoacoustic evaluation, c) maximum phonation time, d) patient’s self-assessment.  </p><p class="abstract"><strong>Results:</strong> In our study of 30 patients with a follow up period of 48 months, we can conclude as follows – a)unilateral vocal cord paralysis does not have age or gender specificity, b)statistically significant vocal cord palsy affects the left side more by 70%, c)post op Gore-tex medialisation thyroplasty showed a statistically highly significant improvement in psychoacoustic, mean phonation time, d)post op Gore-Tex medialisation thyroplasty showed a statistically significant improvement in videostroboscopic analysis.</p><p><strong>Conclusions:</strong> Psycho acoustic, mean phonation time analysis would complement each other in the assessment of the medialisation thyroplasty thus obviating videostroboscopy.</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 Gore-Tex Medialization Thyroplasty in Patients with Unilateral Vocal Cord Paralysis: An Audit of 47 Cases

2011 ◽  
Vol 1 (1) ◽  
pp. 11-13 ◽  
Author(s):  
M Gopinath ◽  
Mukundan Subramanian
Keyword(s):  
Surgical Technique ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Medialization Thyroplasty ◽  
Implant Material ◽  
Unilateral Vocal Cord Paralysis ◽  
The Ideal

ABSTRACT Though the surgical technique of medialization thyroplasty has been standardized, still the ideal implant has not been defined in the management of unilateral vocal cord paralysis. The authors present their experience of Gore-tex as the implant material.

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