Long‐term outcomes in unilateral vocal fold paralysis patients

McLaughlin, Conor W.; Swendseid, Brian; Courey, Mark S.; Schneider, Sarah; Gartner‐Schmidt, Jackie; Yung, Katherine C.

doi:10.1002/lary.26900

Cited by 18 publications

(16 citation statements)

References 13 publications

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“…Finally, we were able to confirm that patients suffering from permanent UVFP with relevant voice and respiratory impairment after complex thyroid surgery substantially benefited from the performed phonosurgical interventions . If the symptoms cannot be relieved by conservative therapies, these established, safe and long‐term effective microlaryngoscopic and transcervical medialisation procedures were shown to significantly improve the voice and quality of life . While tracheostomy is still the choice in life‐threatening BVFP, subsequent implementation of surgical glottal enlargement should be considered for decannulation and closure of the tracheostoma .…”

Section: Discussionmentioning

confidence: 69%

“…19 If the symptoms cannot be relieved by conservative therapies, these established, safe and long-term effective microlaryngoscopic and transcervical medialisation procedures were shown to significantly improve the voice and quality of life. 20,21 While tracheostomy is still the choice in life-threatening BVFP, subsequent implementation of surgical glottal enlargement should be considered for decannulation and closure of the tracheostoma. 22,23 Alternative methods to regain respiratory functionality after BVFP onset by means of more physiological treatments include the development of laryngeal pacemakers, 24 which have, in contrast to current surgical therapies, the potential to improve respiration while preserving voice quality.…”

Section: Phonosurgery Resultsmentioning

confidence: 99%

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Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Sedlmaier

Steinmüller

Hermanns

et al. 2019

Clinical Otolaryngology

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Objectives To compare continuous (C‐IONM) vs intermittent intraoperative neuromonitoring (I‐IONM) in complex benign thyroid surgery, and to follow up patients with loss of signal (LOS) or unilateral vocal fold paralysis (UVFP). Design Retrospective clinical study, prospective case series. Setting University hospital and academic teaching hospital of Charité—University Medicine Berlin, Germany. Participants C‐IONM‐ and I‐IONM‐assisted thyroid surgery was conducted in 357 patients diagnosed with recurrent goitre, Graves’ disease, complex hyperparathyroidism, cervical preoperation (anterior access) and LOS in primary operation (2‐stage thyroidectomy). Main outcome measures To evaluate the incidence of early postoperative and permanent UVFP, and to report the results of phonosurgical therapy in patients suffering from persisting dysphonia. Results In 346 patients enrolled (81.8% female, 18.2% male) with 613 nerves at risk (NAR) being monitored (409 I‐IONM vs 204 C‐IONM), early postoperative UVFP was observed in 10.5% of I‐IONM vs 4.9% of C‐IONM group (P < .05), permanent paralysis in 1.5% of I‐IONM vs 1.0% of C‐IONM group (P = .619). In total, 72 patients (21%) experienced pathological events (19 LOS < 100 μV, 53 transient or permanent UVFP). Three patients with permanent UVFP and persisting dysphonia received phonosurgery with stable improvements of all acoustic‐aerodynamic parameters. Conclusion Compared to I‐IONM, C‐IONM‐application in complex benign thyroid surgery shows a significant reduction of transient UVFP and a non‐significant trend in preventing permanent UVFP. In persistent UVFP with dysphonia, endolaryngeal phonomicrosurgery and transcervical laryngeal framework surgery are long‐term effective treatment approaches to improve vocal function.

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Section: Discussionmentioning

confidence: 69%

Section: Phonosurgery Resultsmentioning

confidence: 99%

Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Sedlmaier

Steinmüller

Hermanns

et al. 2019

Clinical Otolaryngology

View full text Add to dashboard Cite

show abstract

“…They considered that initial underinjection, progression of vocal fold paresis, or loss of injection agent were the causes of reintervention [14]. There are also two studies which report that the treatment decisions in UVFP may not always be predicated on the size of the glottal gap alone [12,15]. Voice deterioration in UVFP has an impact on acoustic parameters and perceptual evaluation.…”

Section: Discussionmentioning

confidence: 99%

Can preoperative results predict the need for future reintervention following injection laryngoplasty for unilateral vocal fold paralysis?

Miaśkiewicz

Panasiewicz

Gos

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose The objective was to investigate whether a patient’s preoperative test results can predict the need for future reoperation in unilateral vocal fold paralysis (UVFP). Methods A single-centre retrospective study was performed. The study group consisted of 18 patients with UVFP who had been treated with injection laryngoplasty but who required further treatment and were augmentated again within 36 months. The control group consisted of 33 injected patients who had not required reintervention up to 36 months later. Results Only glottal gap was associated with a relative risk for reinjection. Glottal gap was found to be severe in 77.8% of the patients from the study group compared to 42.4% of the controls, and the difference was statistically significant. The kind of injected material (calcium hydroxylapatite or hyaluronic acid), age, and voice assessment (perceptual, objective, or subjective) did not seem to affect the likelihood of reoperation being needed. There were no between-group statistically significant differences in individual aspects of the GRBAS scale. The global score was slightly higher in the study group, but it did not reach statistical significance (U = 198.5; p = 0.09). A comparison of VHI scores did not yield statistically significant differences between the study and control groups. No significant differences in objective acoustic voice parameters were observed between the groups. Conclusion Only glottal gap occurred to be associated with a relative risk for reinjection. A kind of injected material (CaHA or HA), age, perceptual, objective and subjective voice assessment do not seem to impact the likelihood of reoperation in patients with UVFP.

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“…The majority of patients with unilateral vocal cord paralysis (UVCP) experience breathy dysphonia and aspiration caused by incomplete glottal closure. 1 Treatment options for UVCP include vocal cord injection, medialization thyroplasty, arytenoid adduction, and laryngeal reinnervation. 2 However, some patients with UVCP show dyspnea on exertion, paroxysmal laryngospasm, or stridor.…”

Section: Introductionmentioning

confidence: 99%

Main branch of ACN‐to‐RLN for management of laryngospasm due to unilateral vocal cord paralysis

et al. 2019

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Objectives/Hypothesis This study explored the feasibility and efficiency of main branch of ansa cervicalis nerve (ACN)‐to‐recurrent laryngeal nerve (RLN) anastomosis for management of paroxysmal laryngospasm due to unilateral vocal cord paralysis (UVCP). Methods Thirteen patients who underwent main branch of ACN‐to‐RLN anastomosis for management of paroxysmal laryngospasm due to UVCP were enrolled in the present study. Multidimensional assessments, including videostroboscopy, voice assessment, and laryngeal electromyography (LEMG), were performed preoperatively and postoperatively. Results This series was limited to UVCP with iatrogenic causes, including thyroidectomy, cervical spine surgery, and thoracic surgery. After main branch of ACN‐to‐RLN anastomosis, all cases showed significant airway improvement, and laryngospasm was completely abolished in 92.3% (12 of 13) of cases. Videostroboscopy showed that the bulging and paradoxical adduction of the affected vocal cord during a sniff were abolished immediately after operation, and there was no significant difference in vocal fold position or glottal closure before versus after the operation. LEMG showed that the postoperative recruitment and amplitude of voluntary motor unit potential in the affected thyroarytenoid muscle during a sniff were significantly decreased compared to preoperative values, and postoperative recruitment showed significant improvement during phonation compared to that preoperatively. Voice assessment showed that there were no significant differences in overall grade, roughness, breathiness, jitter (local), shimmer (local), noise‐to‐harmonics ratio, or maximum phonation time after the operation compared to the preoperative values. Conclusions Main branch of ACN‐to‐RLN anastomosis could have long‐lasting efficacy in the management of paroxysmal laryngospasm due to UVCP, with no apparent compromise of voice quality. Level of Evidence 4 Laryngoscope, 130:2412–2419, 2020

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Long‐term outcomes in unilateral vocal fold paralysis patients

Abstract: 4. Laryngoscope, 128:430-436, 2018.

Cited by 18 publications

References 13 publications

Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Can preoperative results predict the need for future reintervention following injection laryngoplasty for unilateral vocal fold paralysis?

Main branch of ACN‐to‐RLN for management of laryngospasm due to unilateral vocal cord paralysis

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