High‐resolution manometry and swallow outcomes after vocal fold injection medialization for unilateral vocal fold paralysis/paresis

Kammer, Rachael; Jones, Corinne A.; Johnson, Aaron M.; Dailey, Seth H.; McCulloch, Timothy M.; Thibeault, Susan L.

doi:10.1002/hed.25715

Cited by 16 publications

(17 citation statements)

References 41 publications

(50 reference statements)

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“…The decrease in EAT‐10 was similar to that observed by Cates et al, who reported a change from 13.1 ± 13.7 to 6.5 ± 10.0 after medialization in patients with unilateral vocal fold immobility 24 . Swallow outcomes following injection have not been thoroughly investigated 25 . These data add to the growing body of literature supporting the benefits of medialization to address dysphagia, 24,26,27 particularly in patients with isolated UVFP.…”

Section: Discussionsupporting

confidence: 83%

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Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Hoffman

Vandiver

Derise

et al. 2021

Otolaryngol.--head neck surg.

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Objective Patients with unilateral vocal fold paralysis commonly report dysphonia and dysphagia. Dyspnea also occurs, with studies on treatment-related change producing mixed results. Studies including patient-reported outcomes have focused on single-question global scales. The Dyspnea Index (DI) includes 10 questions, is specific to upper airway–related dyspnea, and may better capture these patients’ symptoms. We evaluated change in DI after treatment. Study Design Retrospective review. Setting Academic medical center. Methods Forty-three patients with unilateral vocal fold paralysis underwent injection augmentation (n = 25) or framework surgery (n = 18). DI was recorded preprocedure, 2 to 4 weeks afterward, and at approximately 3 months afterward in 19 patients. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 were also recorded. Change in parameters and correlations were assessed. Obesity, cardiac disease, pulmonary disease, and procedure (injection vs framework surgery) were evaluated for effect on DI. Results Twenty-four patients had an abnormal baseline DI (>10). DI decreased from 14.9 ± 13.8 to 6.5 ± 9.3 after treatment ( P < .001; 95% CI, 4.7-12.1). Twenty-eight scores decreased, 9 remained unchanged, and 6 increased. Change in DI was influenced by the presence of cardiac disease. Decreased DI persisted at 3-month follow-up. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 scores decreased and were correlated with change in DI. Conclusion Upper airway–related dyspnea is common in unilateral vocal fold paralysis, occurring in half of this cohort. Correcting glottic insufficiency may alleviate symptoms. Treatment decision making should consider postprocedural change in dyspnea, especially in patients for whom dyspnea is a motivating factor for seeking treatment.

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Section: Discussionsupporting

confidence: 83%

“…24 Swallow outcomes following injection have not been thoroughly investigated. 25 These data add to the growing body of literature supporting the benefits of medialization to address dysphagia, 24,26,27 particularly in patients with isolated UVFP.…”

Section: Discussionmentioning

confidence: 66%

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Hoffman

Vandiver

Derise

et al. 2021

Otolaryngol.--head neck surg.

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“…Vocal cord paralysis can result in chronic aspiration, particularly when combined with a laryngeal sensory deficit (e.g., a high vagal lesion) [65,66]. This can be prevented with injection medialization laryngoplasty [67][68][69][70][71][72]. To medialize the vocal cords, vocal cord injection can be performed endoscopically, transcervically, or transorally.…”

Section: Vocal Fold Medializationmentioning

confidence: 99%

Aspiration prevention surgeries: a review

et al. 2023

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Background Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and various aspiration prevention surgeries have been introduced, but little is known about them or their benefits. This is a review of the types of aspiration prevention surgery, with the aim of increasing aspiration prevention surgery awareness and their clinical outcomes among medical professionals, which will guide the choices of aspiration prevention surgeries for patients with intractable aspiration. Main body Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50–80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency. Conclusions In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.

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“…8,9,[14][15][16][17][18][19]21 Furthermore, some reports even suggest that IL may in fact be ineffective in decreasing aspiration. 10,14,20 These conclusions are predicated off of case studies that do not have a control group nor do they have follow-up periods appropriate to intended study endpoints. Instead, most of the included studies are uncontrolled before-after observational investigations.…”

Section: Discussionmentioning

confidence: 99%

“…The study results showed no significant change in PAS scores across time points (preinjection, 1 week post-injection, 1 month post-injection). 20 Likewise, Bhattacharyya et al found no significant improvement in PAS scores from pre-injection to postinjection. 12 Oestreicher-Kedem et al reported their experience injecting patients with severe aspiration.…”

Section: Effect Of Interventionmentioning

confidence: 97%

Effectiveness of Injection Laryngoplasty for Aspiration in Acute Iatrogenic Vocal Fold Paralysis: A Systematic Review

Pan

Sadoughi

2020

The Laryngoscope

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Objective/Hypothesis: To review current evidence on effectiveness of injection laryngoplasty on aspiration outcomes in acute unilateral vocal fold paralysis.Study Design: Systematic review. Methods: A literature search was performed on MEDLINE, Embase, Scopus, and the Cochrane Library from inception of each database to May 2019. Inclusion criteria included case series, case-control studies, prospective cohort studies, and randomized controlled trials assessing the outcomes of early injection laryngoplasty on aspiration in unilateral vocal fold paralysis, in the acute setting. Only English articles with adult study populations were included. Two independent investigators screened all abstracts and manuscripts. Data on study design, patient demographics, interventions, and outcome measures were systematically extracted by both authors for included studies.Results: Fourteen case series studies comprising 582 patients were included. Results were not quantitatively synthesized due to the heterogeneity of outcome measures. Eleven studies reported that a majority (ranging 50%-100%) of patients in each respective study showed improvement in diet intake (progression from nil per os to oral) or Penetration-Aspiration Scale (PAS) scores after injection laryngoplasty. However, none of the investigations used a control group, and therefore, did not account for the possibility of improvement of function related to placebo or Hawthorne effects rather than attributed to intervention.Conclusions: No robust evidence was found to support injection laryngoplasty as an effective measure to improve aspiration outcomes in acute iatrogenic vocal fold paralysis. Current practices rely on empirical observations and scarce expert opinions. Further prospective investigations with controlled objective measures are necessary to definitively demonstrate the effectiveness of IL for aspiration management.

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High‐resolution manometry and swallow outcomes after vocal fold injection medialization for unilateral vocal fold paralysis/paresis

Cited by 16 publications

References 41 publications

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis

Aspiration prevention surgeries: a review

Effectiveness of Injection Laryngoplasty for Aspiration in Acute Iatrogenic Vocal Fold Paralysis: A Systematic Review

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