UVCP can seriously compromise phonation, swallowing, and social functions; thus significantly impacting a patient's general health status. Voice physiological function is also a QoLF outcome indicator.

Fat injection laryngoplasty seems to be effective in enhancing acoustic and quality of life outcomes in patients with unilateral vocal cord paralysis. The effect is sustainable over 12 months.

ObjectivesNeuromuscular control, glottal conformation and aerodynamics are the major factors affecting voice performance. We aimed to characterise the degree to which voice improvements following office‐based intracordal hyaluronate injection laryngoplasty (HIL) depend on changes in voice aerodynamics in patients with unilateral vocal fold paralysis (UVFP), by assessing the correlations between these parameters.DesignProspective case series.SettingOtolaryngology Clinics in a Medical Center.ParticipantsPatients with UVFP within 6 months of their first outpatient visit who received single HIL.Main outcome measuresVideolaryngostroboscopy, aerodynamics and laboratory voice analysis were evaluated at baseline and 1 month after HIL. Quantitative laryngeal electromyography was evaluated at baseline to confirm UVFP.ResultsSeventy‐five newly diagnosed patients with UVFP were analysed. The normalised glottal gap area (NGGA) decreased (P < 0.001) (Cohen's dz = 0.94) and all aerodynamic parameters improved (all P < 0.05) (Cohen's dz = 0.38‐1.02) following HIL. Patients undergoing thoracic surgery had more profound aerodynamic impairments both before and after HIL. After adjusting for improvements in NGGA, the improvement in aerodynamics was correlated with voice improvement and most notably with maximum phonation time and jitter/shimmer.ConclusionsHyaluronate injection laryngoplasty improved glottal conformation, aerodynamics and voice, highlighting the benefit of early HIL intervention for patients with UVFP. Patients with UVFP caused by thoracic surgery continued to have poorer aerodynamics post‐HIL, indicating the importance of speech therapy in these patients.

Objectives In patients with unilateral vocal fold paralysis (UVFP), laryngeal electromyography (LEMG) occasionally observes synkinesis in laryngeal muscles, a condition that could impair vocal fold mobility and voice control. This study aims to evaluate the impact of synkinesis on UVFP patients. Study Design A retrospective case-control study. Setting Medical center. Subjects and Methods Patients with UVFP onset >6 months were recruited (N = 104). The outcome measurements included LEMG, quantitative LEMG analysis of thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex, glottal gap measured by videolaryngostroboscopy, voice-related quality of life, and voice acoustic analysis. Results According to the LEMG analysis, 8 patients (8%) had synkinesis, and 96 (92%) did not. In the synkinesis group, TA-LCA turn frequency in the lesioned side was comparable to that in the healthy side ( P = .52). Patients in the synkinesis group had higher TA-LCA turn frequency ( P = .001), higher probability of cricothyroid muscle dysfunction ( P = .04), and better voice-related quality of life ( P = .01) but objective voice outcomes comparable to those in the nonsynkinesis group. Conclusions Patients with synkinesis will have near-complete restoration in TA-LCA turn frequency but still experience voice impairment, a finding that is compatible with the mechanism of aberrant reinnervation. However, patients with synkinesis have better disease-related quality of life than do those without synkinesis.

Despite an initial deterioration of voice and QOL in the first month, patients who underwent TLM recovered to a plateau since the sixth month and then to better than preoperative status afterward. A greater improvement in QOL was seen in patients with poorer baseline voice quality.

Objective: Traditionally, after total laryngopharyngectomy (TLP), patients cannot speak without a prosthesis or an artificial larynx. In Taiwan, most patients use a commercialized pneumatic laryngeal device (PLD). Phonatory tube reconstruction with the anterolateral thigh (ALT) flap is a novel, modified version of synchronous digestive and phonatory reconstruction involving a free muscular cutaneous flap. This study reviewed and compared speech performance between patients who underwent novel flap reconstruction and conventional PLD users.Method: We retrospectively reviewed patients with laryngeal or hypopharyngeal cancer who underwent TLP from August 2017 to September 2019. The voice handicap index (VHI), speech intelligibility, acoustic and aerodynamic analysis results, and speech range profile (SRP) were compared between patients who underwent ALT phonatory tube reconstruction (ALT group) and those using PLDs (PLD group).Results: Twenty patients were included; 13 patients were included in the ALT group, and 7 patients were included in the PLD group. Compared to the PLD group, the ALT group had a better fundamental frequency range (P < .001) and semitone range (P < .001) during speech but showed worse jitter, shimmer, and harmonic-to-noise ratios. The two groups showed comparable VHI and speech intelligibility performance.Conclusions: The ALT phonatory tube, a novel flap for reconstruction, can restore digestive and voice functions simultaneously. Compared with PLD use, ALT phonatory tube reconstruction yields an improved speech range and comparable levels of voice handicap and speech intelligibility, suggesting that the technique is a good alternative for patients after TLP.

Objectives/Hypothesis: Wide variation in postinjury functional recovery is a hallmark of unilateral vocal fold paralysis (UVFP), ranging from zero to full recovery. The present study examined the impact of cricothyroid (CT) muscle involvement on recovery using quantitative laryngeal electromyography (LEMG) of the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex at multiple times postinjury.Study Design: Prospective cohort study in a medical center.Methods: Eighty-one patients with UVFP (37 males and 44 females) received an initial assessment of quantitative LEMG, stroboscope, acoustic voice analysis and 36-Item Short Form Survey quality-of-life questionnaire at 3 to 6 months after UVFP onset and a follow-up assessment at 12 months after UVFP onset.Results: The initial and follow-up assessments were performed at 4.3 AE 1.9 and 12.5 AE 1.3 months after UVFP onset, respectively. The peak turn frequency of the TA-LCA muscle complex on the lesion side was improved at the follow-up (470 AE 294 Hz) compared with the initial assessment (300 AE 204 Hz) (P < .001). Patients were also divided into two groups with (n = 27) and without (n = 54) CT involvement, respectively. TA-LCA muscle complex turn frequency improved in patients without CT involvement (from 277 AE 198 to 511 AE 301 Hz; P < .001), but not in those with CT involvement (from 345 AE 211 to 386 AE 265 Hz; P = .46). Seventy-one of all patients received early intervention with intracordal hyaluronate injection, showing similar therapeutic effects in those with and without CT involvement.Conclusions: Acute UVFP with combined TA-LCA muscle complex and CT muscle involvement has a poor prognosis, with poorer recovery of TA-LCA muscle complex recruitment. Early interventions should be considered in patients with UVFP with CT involvement.

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