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

<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>

Cricopharyngeal myotomy for delayed Cricopharyngeal dysfunction after head and neck surgery – case report

Background Head and neck surgeries can perturb normal structures of neck muscles and nerve innervations, which are supposed to function in harmony to allow complicated process like swallowing. It is still likely that cricopharyngal dysfunction emerges years after the head and neck surgeries. Case presentation We report a case with history of left unilateral vocal cord immobility and development of dysphagia and aspiration 2 years after radical thyroidectomy with neck lymph nodes dissection and medialization thyroplasty. Cricopharyngeal dysfunction was impressed and was confirmed with visualization of cricopharyngeal narrowing segment in radiographic contrast swallow examination. The patient was treated successfully by cricopharyngeal myotomy, achieving long-term relief in our 4 years of follow up. Conclusions Our case of delayed cricopharyngal dysfunction after radical thyroidectomy and medialization thyroplasty shows that it is important to follow up swallowing functions after patients with UVCI undergo medialization thyroplasty. In the event of delayed manifestation of cricopharyngeal function, it can still be treated successfully by cricoharyngeal myotomy, achieving long term relief of dysphagia.

Pre- and intraoperative acoustic and functional assessment of the novel APrevent® VOIS implant during routine medialization thyroplasty

Purpose Persistent unilateral vocal fold paralysis (UFVP) with glottal insufficiency often requires type I medialization thyroplasty (MT). Previous implants cannot be adjusted postoperatively if necessary. The newly developed APrevent® VOIS implant (VOIS) can provide postoperative re-adjustment to avoid revision MT. The objective of this pilot study is to evaluate the VOIS intraoperatively concerning voice improvement, surgical feasibility and device handling. Methods During routine MT, VOIS was applied short time in eight patients before the regular implantation of the Titanium Vocal Fold Medialization Implant (TVFMI™). In all patients, perceptual voice sound analysis using R(oughness)–B(reathiness)–H(oarseness)-scale, measurement of M(aximum)–P(honation)–T(ime) and glottal closure in videolaryngoscopy were performed before and after implanting VOIS/TVFMI™. Acoustic analyses of voice recordings were performed using freeware praat. Surgical feasibility, operative handling and device fitting of VOIS and TVFMI™ were assessed by the surgeon using V(isual)-A(nalog)-S(cale). Data were statistically analyzed with paired t test. Result All patients showed significant improvement of voice sound parameters after VOIS/TVFMI™ implantation. The mean RBH-scale improved from preoperative R = 2.1, B = 2.3, H = 2.5 to R = 0.6, B = 0.3, H = 0.8 after VOIS and R = 0.5, B = 0.3, H = 0.8 after TVFMI™ implantation. The mean MPT increased from preoperative 7.9 to 14.6 s after VOIS and 13.8 s after TVFMI™ implantation. VOIS/TVFMI™ achieved complete glottal closure in 7/8 patients. The satisfaction with intraoperative device fitting and device handling of VOIS was as good as that of TVFMI™. Conclusion The novel APrevent® VOIS implant showed similar intraoperative voice improvement compared to routinely used TVFMI™ without adverse device events and with safe device fitting.