Long-term voice outcomes of laryngeal framework surgery for unilateral vocal fold paralysis

Mes, Stephanie D.; Hendriksma, Martine; Heijnen, Bas J.; Goudsmit, Ben F.J.; Jansen, Jeroen C.; Langeveld, Antonius P. M.; Sjögren, Elisabeth V.

doi:10.1007/s00405-021-07177-7

Cited by 11 publications

(7 citation statements)

References 43 publications

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“…Mortensen et al demonstrated significant improvements in ML with AA in acoustic and aerodynamic parameters postoperatively at approximately 3 months [ 6 ]. Mes et al assessed the voice outcomes of MT + AA using the VHI, perceptual evaluation, and aerodynamic evaluation 12 months postoperatively [ 24 ]. There have been few reports on the results of AA more than 2 years postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Long-term voice evaluation after arytenoid adduction surgery in patients with unilateral vocal fold paralysis

Watanabe

Hirano-Kawamoto

Kobayashi

et al. 2023

Eur Arch Otorhinolaryngol

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Purpose Laryngeal framework surgery, including medialization laryngoplasty and arytenoid adduction (AA), is expected to have a lasting or permanent effect in patients with unilateral vocal fold paralysis (UVFP); however, there are few reports about the long-term outcomes of AA. This study aimed to evaluate the long-term postoperative effects of AA surgery and examine its stability and reliability. Methods This study collected the voice handicap index (VHI) questionnaire from patients with UVFP who underwent AA more than 2 years previously. The VHI values preoperatively and 3 months postoperatively (early postoperative evaluation) were retrospectively calculated, and VHI values more than 2 years after surgery (late postoperative evaluation) were collected by mailing a sheet to the patients and asking to fill and return it. Possible influenced subscales such as age, sex, causes of UVFP, affected side, and surgeons were also analyzed. Results A total of 77 patients with UVFP who underwent AA had significantly lower early and late postoperative evaluations than preoperative evaluations. In 38 patients with no missing values, there were no significant differences between early and late postoperative evaluations, measured at a median of approximately 5 years. There were also no significant differences between early and late postoperative evaluations in any of the subscale groups. Conclusion Patients with UVFP who underwent AA surgery achieved stable voice improvement in the long term after surgery.

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Section: Discussionmentioning

confidence: 99%

Long-term voice evaluation after arytenoid adduction surgery in patients with unilateral vocal fold paralysis

Watanabe

Hirano-Kawamoto

Kobayashi

et al. 2023

Eur Arch Otorhinolaryngol

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“…In general, an average grade of an 8 is considered a very good result. This rating system has also been described in one of our previous publications [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Subsequently, they received voice therapy by an experienced speech-language therapist in the first week after surgery. Voice therapy included resonance exercises and vocal hygiene advices[ 16 ].…”

Section: Methodsmentioning

confidence: 99%

“…Several authors have suggested that a study with intraoperative measurements of the results of MT and AA could reveal what the additional value of AA would be [ 7 , 9 , 16 ]. Therefore, in this study, voice outcome assessment was performed intraoperatively after medialisation only and after the addition of an arytenoid adduction to evaluate their individual contribution to voice outcome.…”

Section: Introductionmentioning

confidence: 99%

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Voice outcome in medialisation thyroplasty with and without arytenoid adduction: a prospective comparison using intraoperative voice measurements

Mes,

van der Jagt,

Jansen

et al. 2024

Eur Arch Otorhinolaryngol

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Purpose Arytenoid adduction as an addition to medialisation thyroplasty is highly advocated by some surgeons in selected cases but deemed less necessary by others in patients with unilateral vocal fold paralysis. This study aims to evaluate the additional benefits on voice outcome of arytenoid adduction in patients with unilateral vocal fold paralysis undergoing medialisation thyroplasty using intra-operative voice measurements. Design/methods A prospective study was conducted. Voice audio recordings were obtained at 4 moments; 1. direct prior to the start of surgery, 2. during surgery after medialisation thyroplasty, 3. during surgery after medialisation and arytenoid adduction, 3 months postoperative. At these same timepoints patients rated their own voice on a numeric rating scale between 0 and 10. The blinded recordings were rated by consensus in a team of experienced listeners, using the Grade of the GRBAS scale. Furthermore, the Voice Handicap Index was administered before and at 3 months after surgery. Results Ten patients who underwent medialisation and arytenoid adduction at our tertiary referral hospital between 2021 and 2022, were included. One patient was excluded after surgery. The intraoperative measurements showed a Grade score of 1.4 preoperatively, improving to 1.2 after medialisation, 1.2 after medialisation and arytenoid adduction, and further improving to 0.4 at 3 months postoperative, which was a not statistically significant improvement (p = 0.2). The intraoperative subjective numeric rating scale showed a statistically significant improvement from 3.9 preoperatively, to 6.1 after medialisation, 7.1 after medialisation and arytenoid adduction and a 7.6 at 3 months postoperative (p = 0.001). The Voice Handicap Index total score showed a statistically significant improvement from 71 points before surgery to 13 at 3 months after surgery (p = 0.008). Conclusions Our study using intraoperative voice measurements indicate that the addition of arytenoid adduction to medialisation thyroplasty is a benefit in selected patients although more studies are needed due to the many limitations inherent to this field of investigation.

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“…In this numeric rating scale, 1 is considered very poor, 10 outstanding, 6 and above is considered a pass, 5 and below a fail. 12 Study-specific questionnaire…”

Section: Patient Rating Of Voice Aspectsmentioning

confidence: 99%

Long-term outcomes of bilateral medialisation thyroplasty in patients with vocal fold atrophy with or without sulcus

van den Broek,

Heijnen,

van der Valk

et al. 2023

J. Laryngol. Otol.

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Objective Evaluate long-term voice outcome after bilateral medialisation thyroplasty in glottic insufficiency due to vocal fold atrophy with or without sulcus. Methods Patients after medialisation thyroplasty for vocal fold atrophy with or without sulcus were identified. Long-term post-operative subjective voice outcomes (> 1 year) using Voice Handicap Index-30, subjective ratings on voice aspects and study-specific questionnaire were compared to pre-operative and shorter-term (1 year) values. Results Thirty-six patients were identified, of which 26 were included (16 atrophy, 10 sulcus) with median follow up of 6.7 years. Mean Voice Handicap Index score at > 1 year (40.0) showed clinically relevant (≥ 15 for groups) and statistically significant improvement compared to pre-operative score (58.1) and remained stable compared to post-operative score (35.7) at one year. Ten patients (56 per cent) reported clinically relevant improvement (≥ 10) after more than five years. Conclusion Long-term improvement in subjective voice outcomes is attainable in a significant proportion of patients undergoing bilateral medialisation thyroplasty for atrophy with or without sulcus.

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Long-term voice outcomes of laryngeal framework surgery for unilateral vocal fold paralysis

Cited by 11 publications

References 43 publications

Long-term voice evaluation after arytenoid adduction surgery in patients with unilateral vocal fold paralysis

Long-term voice evaluation after arytenoid adduction surgery in patients with unilateral vocal fold paralysis

Voice outcome in medialisation thyroplasty with and without arytenoid adduction: a prospective comparison using intraoperative voice measurements

Long-term outcomes of bilateral medialisation thyroplasty in patients with vocal fold atrophy with or without sulcus

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