Pre and Post Operative Voice Analysis After Medialization Thyroplasty in Cases of Unilateral Vocal Fold Paralysis

Abstract

The present study was undertaken to assess the efficacy of medialization thyroplasty on outcome of voice quality in vocal cord paralysis by analyzing the voice. A total 19 patients with vocal cord paralysis of different etiologies were included in the study. Preoperative voice analysis was done by voice recordings, GRBAS score, maximum phonation time (MPT) and acoustic analysis using Dr Speech software (University version 4.0) using habitual fundamental frequency (F0), jitter %, shimmer % and normalized noise energy (NNE) as parameters. 18 patients underwent type 1 or medialization thyroplasty alone and 1 patient had undergone medialization thyroplasty along with arytenoids adduction. Post operative voice analysis was done using same parameters. There was post operative improvement of voice in 16 patients whereas 3 patients showed no significant improvement. Mean preoperative MPT was 4.8947 s and post operative was 13 s. Mean preoperative GRBAS score was 76.1579 and post operative was 30. On acoustic analysis, mean preoperative habitual fundamental frequency (F0), jitter %, shimmer % and NNE was 278.16 Hz, 1.7, 6.81 and 1.81 dB respectively whereas post operative mean was 132.37 Hz, 0.41, 1.65 and 123.38 dB respectively. Thyroplasty offers good voice outcome in patients of uncompensated vocal cord paralysis. Improvement can be documented in terms of perceptual evaluation of voice and acoustic analysis as well as maximum phonation time in addition to voice recording.

The suspended endoscopy technique (SET) for intra-operative assessment in awake type I thyroplasty—how I do it

“…It is of low cost, and utilizes instruments and resources which are already readily available in most ENT departments. Although not the focus of this paper, the results of the parameters tested show that this technique is effective (mean improvement in MPT 9.7 s) and comparable to previously published data on voice post standard type I thyroplasty (8)(9)(10), with no additional complications.…”

Using Innovative Acoustic Analysis to Predict the Postoperative Outcomes of Unilateral Vocal Fold Paralysis

“…However, in the present study only an increase in MPT was found in both the success and failure groups after lipoinjection laryngoplasty, while no changes were found in GRBAS. The reason may be that lipoinjection laryngoplasty improves the glottic closure efficiency, and MPT was useful to assess the improvements [ 33 ]. GRBAS is emphasized in the perceptual assessment of voice quality [ 32 ].…”

“…A recent study conducted tests on different vowels and attributed dysphonia to the different supraglottal changes during [a] and [i] phonation, which, in turn, affect vocal tract resonances [ 32 ]. A dynamic magnetic resonance imaging study demonstrated the different movement of the vocal folds for [a] and [i] vowels and revealed a lower larynx position in [a] vowel production than in [i] vowel production [ 33 ]. However, differences in testing [a] and [i] persist even in the LP model, in which voicing comes directly from the vocal fold and is not affected by the actions of the vocal tract, such as the pharynx, oral cavity, and tongue.…”

Reliability of OperaVOX against Multidimensional Voice Program (MDVP)

“…It measures irregularity of mucosal vibration of the vocal folds that may affect the F0, jitter, shimmer and NHR. The acoustic parameters were documented in papers reporting voice improvement in unilateral vocal fold paralysis patients following surgical intervention.…”