Arytenoid asymmetry: Is it the most predictive parameter for arytenoid adduction in unilateral vocal fold paralysis?

Menon, Jayakumar; Mathew, Amrita Suzanne; Nath, Soumya Sankar

doi:10.1017/s0022215121000475

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…34 Lastly in support of the exposition that AAA is a secondary laryngeal adaptation, it has been observed in studies involving patients with unilateral vocal fold immobility with AAA, that arytenoid adduction surgery is not always required in addition to Medialization Thyroplasty in order to achieve a satisfactory voice. 35 It has also been observed that not all patients who have undergone arytenoid adduction surgery have the arytenoids restored to perfect symmetry despite a significant improvement in voice postoperatively. 36 These observations coupled with the incidental finding of arytenoid asymmetry by Lindestad et al 16 in 70% of a nondysphonic population, further endorsed our conclusion that AAA which closely parallels an abnormal muscle tension posture is secondary to a laryngeal pathology that interferes with normal phonatory function.…”

Section: Discussionmentioning

confidence: 99%

Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps?

Menon

Mathew

2022

Ann Otol Rhinol Laryngol

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Objectives: To evaluate the relationship between arytenoid adduction asymmetry (AAA) and the demographic and morphological characteristics of true vocal fold (TVF) polyps and establish the cause and effect relationship between AAA and TVF polyps. Methods: Videolaryngostroboscopic findings of 163 patients with TVF polyps were retrospectively reviewed and categorized into Group 1 with AAA or Group 2 without AAA. Demographic details, clinicomorphological polyp characteristics, supraglottic phenomena, and AAA attributes were analyzed. Results: Group 1 was younger than Group 2 (fourth vs fifth decade; P = .0066). Polyp characteristics showed no significant intergroup differences. The association between AAA and false vocal fold (FVF) adduction (65.28% vs 47.62% in Group 1 and 2 respectively; P = .0441) was significant. In relation to TVF polyp laterality, contralateral and bilateral AAA and FVF adduction respectively, was significant. Conclusion: AAA is a compensatory laryngeal adaptation akin to a FVF adduction muscle tension pattern. With a concomitant laryngeal pathology and high vocal demand, AAA is a consequence and not the cause for underlying laryngeal pathology which hinders glottic closure.

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Section: Discussionmentioning

confidence: 99%

Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps?

Menon

Mathew

2022

Ann Otol Rhinol Laryngol

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“…The goal of this surgery is to improve glottal closure by medializing the vocal folds 6,10 . This process is thought to alter quantitative measures of the vocal fold morphology including glottal gap area and vocal fold bowing 5,9,11 . Changes in these measures are frequently observed following bilateral thyroplasty, but the magnitude of these changes and how it affects voice is unclear.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Evaluation of Vocal Bowing Following Bilateral Thyroplasty in Age‐Related Vocal Atrophy

Cvancara,

Baertsch,

de Leon

et al. 2023

The Laryngoscope

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ObjectiveAge‐related vocal atrophy (ARVA) is associated with vocal fold bowing, persistent glottal gap during phonation, and dysphonia. Bilateral medialization thyroplasty is sometimes performed in patients with ARVA to improve vocal fold closure and voice. We set out to quantify stroboscopic changes in vocal fold bowing, glottal closure, and abduction angle following bilateral thyroplasty and determine how these changes affect voice quality among patients with ARVA.MethodsFifteen individuals with ARVA who underwent bilateral medialization thyroplasty were included in this study. Two independent investigators calculated bowing index (BI), normalized glottal gap area (NGGA), and maximum abduction angle from laryngostroboscopic exams using ImageJ™. Consensus Auditory‐Perceptual Evaluation of Voice (CAPE‐V) and patient‐reported measures were collected before and after thyroplasty.ResultsThyroplasty resulted in a 10‐point improvement in overall CAPE‐V (Mean dif −10; 95% CI –17, −3.3, p < 0.01) and VHI‐10 (mean dif −3.8; 95% CI –9.8, 2.3, p = 0.19, n = 8). NGGA and BI significantly decreased following surgery (mean dif −78; 95% CI –155, −1.5, p = 0.05; and mean dif −2.1; 95% CI –2.4, −0.84, p < 0.01, respectively). BI correlated with CAPE‐V scores (r = 0.66, 95% CI 0.22, 0.87, p < 0.01). When considering the normalized combined contributions of both NGGA and BI, there was a stronger correlation in CAPE‐V scores (r = 0.87, 95% CI 0.50, 0.97, p < 0.01) compared with either measure alone.ConclusionsThyroplasty resulted in a decrease in vocal fold bowing, glottal gap area, and CAPE‐V scores in patients with ARVA. Correction of vocal bowing and glottal gap, following bilateral thyroplasty, improved voice measures following surgery. Quantitative evaluation of vocal fold morphology may be valuable when assessing the severity and treatment‐response in patients with ARVA following bilateral thyroplasty. Laryngoscope, 2023

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“…The controversy of adding arytenoid procedure to ML still continues today. 8,9 This study was conducted to find a possible answer to this controversy. This study is also the first clinical study comparing ML + AA with ML + AApexy.…”

Section: Introductionmentioning

confidence: 99%

Unilateral Vocal Fold Paralysis With Large Posterior Glottic Gap: Is Arytenoid Procedure Necessary?

Yılmaz

Özer

2021

Ann Otol Rhinol Laryngol

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Objectives: For unilateral vocal fold paralysis (UVFP) with large posterior glottic gap medialization laryngoplasty (ML) + arytenoid adduction (AA), ML + adduction arytenopexy (AApexy), and ML alone using prosthesis with posterior extension are possible solutions. This study was carried out to elucidate the controversy among these solution options. Methods: Retrospective cohort. Tertiary referral center. One hundred forty patients with UVFP with large posterior glottic gap. Group 1 had 30 patients with ML + AA; Group 2 had 25 patients with ML + AApexy; Group 3 had 29 patients with ML using Isshiki prosthesis; Group 4 had 26 patients with ML using Montgomery prosthesis; Group 5 had 30 patients with ML using prosthesis with large posterior extension. Glottic closure using videolaryngostroboscopy, GRBAS, VHI-30, EAT-10, acoustic and aerodynamic analysis was carried out pre- and 1-year-postoperatively. Results: Preoperatively there was no significant difference in any parameters studied among all study groups ( P > .05). Except F0, speaking F0 and EAT-10, all other parameters in acoustic and aerodynamic analysis, glottic closure, GRBAS, and VHI-30 scores were significantly better postoperatively in Groups 1 and 2 compared to Groups 3 to 5 ( P < .05). Conclusions: In patients with UVFP and large posterior glottic gap, ML + AA and ML + AApexy seem to do better subjectively and objectively, acoustically and aerodynamically, when compared to ML using prosthesis with and without large posterior extension. ML alone does not appear to close posterior glottic gap. Therefore, it is a better and more reasonable option to perform arytenoid procedure when there is large posterior glottic gap in UVFP.

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Arytenoid asymmetry: Is it the most predictive parameter for arytenoid adduction in unilateral vocal fold paralysis?

Cited by 7 publications

References 22 publications

Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps?

Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps?

Quantitative Evaluation of Vocal Bowing Following Bilateral Thyroplasty in Age‐Related Vocal Atrophy

Unilateral Vocal Fold Paralysis With Large Posterior Glottic Gap: Is Arytenoid Procedure Necessary?

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