Bilateral medialization thyroplasty in patients with vocal fold atrophy with or without sulcus

Abstract

Purpose To evaluate voice outcome after bilateral medialization thyroplasty in patients with non-paralytic glottic insufficiency due to vocal fold atrophy with or without sulcus. Methods Retrospective cohort study on 29 patients undergoing bilateral medialization thyroplasty for vocal fold atrophy (14 procedures) or atrophy with sulcus (15 procedures) between October 2012 and November 2017. Voice data were collected and analyzed for the preoperative and the 3-and 12-month postoperative time point according to a standardized protocol, including Voice Handicap Index (VHI)-30 and perceptual, acoustic and aerodynamic parameters. Failure rate was based on number of revisions within 12 months and non-relevant improvement (< 10 points) in VHI-30 at 12 months. Results There was a clinically relevant (≥ 15 points) and statistically significant improvement (p < 0.0001) in the VHI-30 (preoperative: 55.8 points; postoperative at 12 months: 30.9 points). Fundamental frequency for male subjects decreased significantly from 175 to 159 Hz (p = 0.0001). The pre-and post-operative grade of dysphonia was significantly lower in patients with atrophy compared to atrophy and sulcus (mean difference 0.70, p = 0.017). Conclusion Bilateral medialization thyroplasty is a valid treatment option for patients with atrophy with or without sulcus. Outcomes are comparable to other methods reported in literature. However, there is a great need for larger, prospective studies with long-term follow-up to gain more insight into the comparative voice outcomes for the different forms of surgery for patients with glottic incompetence due to atrophy with or without sulcus.

A Systematic Review on Surgical Treatments for Sulcus Vocalis and Vocal Fold Scar

“…Three studies 14,19,21 included exclusively unilateral procedures, and five others only bilateral procedures. 20,26,27,33,34 Sixteen studies 9,16,17,20,[22][23][24][25]28,[32][33][34][35][38][39][40] (51.6%) included follow-ups greater than 6 months, and only in two studies 9,16 (6.5%) follow-up was longer than 1 year, for every patient. Of the 31 articles, 23 (74.2%) 9,13,17,21,24,25,[27][28][29][30][32][33][34][35][36]39,40 outlined self-reported outcomes, 24 (77.4%) 9,12,17,18,[21][22][23][24][25]…”

“…Combined simultaneous therapies address both components. Some recent papers 33,34 seem to favor a sequential approach, with medialization techniques used as the first approach, based on the European Laryngeal Society recommendation for being the least invasive possible on the treatment of scar. 42 Outcomes that most consistently improve are selfreported outcomes, with few exceptions, 9,19,28 that include experimental techniques not reproduced in other studies.…”

“…Sole indirect treatments as a mainstay for sulcus and/or scar were performed in six of our reviewed studies 9,[31][32][33][34][35] (Table III). These studies included two different techniques: type I thyroplasty 9,31,34 and fat injection augmentation. 9,32,33,35 Self-reported outcomes had general significant improvement in most studies.…”

Vocal fold sulci – what are the current options for and outcomes of treatment?

“…Years to come will demonstrate the advances in medical and tissue engineering in developing tools to restore the microanatomy and molecular biology in sulcus vocalis. Important breakthroughs have already been made and new studies are showing promising results [46,[61][62][63][64][65][66][67], however, further research is required until a standard technique to address sulcus vocalis is found, ending the ancient struggle of the vocal fold to freely vibrate.…”

An Analysis of Postoperative Complications in Medialization Thyroplasty: NSQIP Data

“…Medialization thyroplasty procedures have been shown to result in significant voice restoration at 6 months after treatment as demonstrated by improved ratings of grade of dysphonia, roughness, breathiness, asthenia, and strain (GRBAS) scale [9]. Furthermore, research has shown significant improvements in Voice Handicap Index (VHI)-30 and Voice-Related Quality of Life (VRQOL) after type I thyroplasty procedures [10, 11]. While the benefits of medialization thyroplasty have been described, this procedure is not without risk.…”