Thyroplasty has virtually replaced Teflon injection as the procedure of choice for treatment of the unilateral paralyzed vocal cord. Previous studies have shown that Teflon injection, by stiffening the vocal cord, decreases the extrathoracic airway obstruction occasionally measured by pulmonary function testing in patients with unilateral vocal cord paralysis. We became interested in the effect of thyroplasty on extrathoracic airflow. In this prospective study, patients underwent prethyroplasty and postthyroplasty pulmonary function testing. Flow volume loops combined with traditional spirometry were used. Postoperative pulmonary function tests were performed at least 2 months after surgery to allow resolution of surgical edema. Our study results support the previous finding that vocal cord paralysis alone causes some degree of extrathoracic obstruction. However, in contrast to Teflon injection, thyroplasty decreased extrathoracic airflow in all but 1 patient, and by criteria based on the ratio of the midexpiratory flow to the midinspiratory flow, caused new postoperative extrathoracic obstruction in 27% of patients. Symptomatic evidence of this obstruction may be more evident in those active patients with more ventilatory demand.

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Poster Presentations P191 POSTERS Conclusion:The present study showed that, based on the methodology proposed, the diffusion of a solution injected into the TA occurs in almost all cases toward the CAL muscle. The CT muscle was affected in half of the cases. Although rarely, it can also achieve the PCA muscle. Laryngology/Broncho-EsophagologyDisease-Specific Self-efficacy in Spasmodic Dysphonia Amanda Hu (presenter); Derek Isetti; Al Hillel, MD; Pat Waugh, MS, CCC-SLP; Tanya K. Meyer, MD Objective: Self-efficacy (SE) is an optimistic self-belief that one can cope with adversity. For chronic conditions, a standardized measure of SE is a strong predictor of health behaviors. Our objectives were to study SE in spasmodic dysphonia (SD) and to develop a disease-specific SE-SD scale.Method: Disease-specific SE-SD items were developed through expert opinion. These items, general SE scale, Voice Handicap Index (VHI), Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), and Hospital Anxiety and Depression Scale (HADS) were administered to SD patients who presented to University of Washington for botulinum toxin injections over a 6-month period.Results: Eighty SD patients completed the study with a mean age 58.7 years. The general self-efficacy score (Cronbach's α = .871) was 34.7 ± 3.7 out of 40 and was negatively correlated with VHI (r = -0.22, P = .08), CAPEV (r = -0.14, P = .36), and HADS-A (r = -0.50, P < .001) and HADS-D (r = -0.53, P < .001). Factor analysis was performed and selected 7 items from the general self-efficacy scale and 6 diseasespecific SE-SD items to generate a 13-item disease specific SE-SD scale (Cronbach's α = .913). Disease-specific SE-SD score was 43.9 ± 5.6 out of 52 and is negatively correlated with VHI (r = -0.35, P = .001), CAPE-V (r = -0.29, P = .026), HADS-A (r = -0.49, P < .001), and HADS-D (r = -0.58, P < .001).Conclusion: SD patients who are established with botulinum toxin injections have a high degree of general SE and diseasespecific SE. Patients with higher SE demonstrate higher subjective and objective vocal quality and lower levels of anxiety and depression. A 13-item disease specific SE-SD scale has been developed. Laryngology/Broncho-Esophagology Experimental Laryngeal Granuloma in Rats with GERD Rintaro Shimazu, MD (presenter); Yuichiro Kuratomi, MD, PhD; Akira InokuchiObjective: Acid reflux and mucosal injury of the larynx may be involved in the development of laryngeal granuloma. This study developed an experimental laryngeal granuloma by mechanical injury to the vocal cord mucosa in rats with chronic acid refluesophagitis to clarify the pathological mechanism of laryngeal granuloma.Method: An experimental rat model of chronic acid reflux esophagitis was surgically created. A plastic bar was inserted into the trachea of the model rat to mechanically injure the vocal cord mucosa. The pharynx, larynx, and esophagus of these rats were observed histologically every 2 weeks after the operation.Results: A granuloma was observed in the vocal cord mucosa of the rat after 2 wee...