Ⅰ型甲状软骨成形术治疗单侧声带麻痹的嗓音学分析

目的 探讨Ⅰ型甲状软骨成形术治疗单侧声带麻痹的嗓音学特征.方法 应用美国Kay公司的MDVP 5105软件对16例单侧声带麻痹患者手术前、后嗓音声学参数进行分析.结果 16例(100％)患者声学参数基频、频率微扰、振幅微扰及最长声时平均值与术前明显改善(P＜0.050,主观感觉满意.结论 Ⅰ型甲状软骨成形术对改善单侧声...     

Long-term effects of micronized Alloderm injection for unilateral vocal fold paralysis

OBJECTIVES: Micronized Alloderm (Cymetra) is a relatively new product used for vocal fold augmentation. Previous studies evaluating possible long-term effectiveness of this product have shown mixed results. The objective of this present study is to reassess possible long-term results of Cymetra injection laryngoplasty in patients with unilateral true vocal fold paralysis. STUDY DESIGN: Retrospective review of patients with unilateral true vocal fold paralysis who received Cymetra injection laryngoplasty between March 2001 and March 2004. METHODS: Preoperative voice samples and videostroboscopic findings were compared with the most recently available postoperative data to assess efficacy of the procedure. A panel of voice experts analyzed both vocal and vibratory function in these samples. In addition, pre- and postoperative voice-related quality of life measures and patients' self-ratings of voice outcomes were compared. RESULTS: Twenty patients (7 male, 13 female; 14 with left-sided paralysis, 6 with right-sided paralysis) were identified in the study population. Cymetra injection was performed an average of 45.1 months after onset of vocal fold paralysis (range -216 months), and average follow-up postinjection was 11.2 (range -35) months. Comparing pre- and postoperative measures, voice quality (P < .0001), glottal closure (P < .0001), and degree of vocal fold bowing (P < .0001) were all improved by injection. Quality of life measures and patients' self-perceptions of vocal quality were also improved (P < .01). Fifteen (75%) patients showed long-lasting results. Eight patients showed improvement for more than 12 months after injection. CONCLUSION: Cymetra injection laryngoplasty offers improved vocal and vibratory function to patients with unilateral true vocal fold paralysis. The benefits of such medialization may be longer lasting than previously reported, and further long-term study is warranted.     

Ansa-RLN reinnervation for unilateral vocal fold paralysis in adolescents and young adults

OBJECTIVE/HYPOTHESIS: To assess the outcomes of management of unilateral vocal fold paralysis by ansa-RLN reinnervation in a series of patients ages 12-21. STUDY DESIGN: Clinical outcomes study. METHODS: Six consecutive adolescents and young adults (ages 12-21 years) seeking treatment for unilateral vocal fold paralysis and glottal incompetence underwent ansa-RLN neurorraphy. Pre- and post-operative voice recordings acquired at least 1 year following surgery were submitted to acoustic and perceptual analysis. Patient-based measures were also taken. RESULTS: Mean perceptual visual analogue scale rating of dysphonia severity (0mm=profoundly abnormal voice, 100mm=completely normal voice) improved from 50mm pre-operatively to 82mm post-operatively. Mean maximum phonation time improved from 6.5s to 13.2s. Pitch and dynamic range were also observed to improve. Global self-ratings of voice function (0-100%) increased from 31.2% to 81.6% of normal. CONCLUSIONS: Ansa-RLN reinnervation is an effective treatment option for adolescents and young adults with unilateral vocal fold paralysis. The procedure has the potential to improve vocal function substantially, especially in those with isolated paralysis of the recurrent laryngeal nerve. The procedure alleviates the disadvantages associated with other surgical options for this age group.     

Polydimethylsiloxane particles for permanent injection laryngoplasty

OBJECTIVES: Polydimethylsiloxane (PDMS) particles are a nonresorbable material that allows for permanent vocal fold augmentation. This study investigated morbidity and voice quality in patients treated for unilateral vocal fold paralysis by injection of PDMS particles. METHODS: Fourteen patients who had neurogenic unilateral vocal fold paralysis of different causes were included in this prospective study. Each patient underwent videostroboscopic assessment before and after operation. Friedrich's dysphonia index (DI), a score system combining subjective and objective parameters, was used to describe voice quality. A DI of 0 reflects a normal voice, and a DI of 3 stands for complete aphonia. The PDMS particles were injected into the paraglottic space by microlaryngoscopy under general anesthesia. RESULTS: The median follow-up was 4.1 months. There was no complication attributable to the injection of PDMS particles. The mean DI was 2.8 before operation. After the operation, voice quality improved significantly in each patient, as reflected by a mean postinjection DI of 1.4. CONCLUSIONS: Particles of PDMS provide a relatively safe and minimally invasive option for permanent vocal fold augmentation. The functional results in terms of voice improvement are comparable to those obtained with other techniques, including thyroplasty. In the European Community, PDMS particles are officially approved for use in the human larynx.     

Voice acoustics after autologous fascia injection for vocal fold paralysis

OBJECTIVES: The present study was carried out to assess the impact of fascial injection on voice acoustics Preliminary results had suggested that voice, as rated by a panel of listeners, was significantly improved after autologous fascia augmentation of a paralyzed vocal fold. STUDY DESIGN: A prospective study among patients with unilateral vocal fold paralysis was carried out. Eighteen subjects were analyzed 9 months (mean) after the procedure. METHODS: The preoperative and postoperative samples of vowel /a/ were analyzed by Key Elemetrics (Lincoln Park, NJ). Computerized Speech Lab. RESULTS: There was a significant improvement (P<.05) in all parameters measured, including jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time. No laryngeal complications were seen. CONCLUSIONS: According to these preliminary results, vocal fold augmentation by an injection of autologous fascia seems a simple, inexpensive, reliable and safe method to restore voice quality after unilateral vocal fold paralysis.     

Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis

Injection laryngoplasty is one of the procedures for treating unilateral vocal fold paralysis. This is a preliminary report on modified injection laryngoplasty, ie, injection of liposuctioned autologous fat into the larynx and hypopharynx of patients who have aspiration and voice disorders after vocal fold paralysis. Lipoinjection was performed in 3 patients with these complaints with the endolaryngeal microsurgical technique under general anesthesia. The locations of fat injection were the vocal fold, the false vocal fold, the aryepiglottic fold of the larynx, and the medial wall of the pyriform sinus of the hypopharynx. Lipoinjection into the vocal fold, false vocal fold, and aryepiglottic fold strengthened laryngeal closure. Lipoinjection, performed into the thyroarytenoid muscle lateral to the oblong fovea of the arytenoid cartilage, made arytenoid cartilage rotation possible, and consequently strengthened laryngeal closure. Lipoinjection into the medial wall of the pyriform sinus of the hypopharynx reduced its capacity; consequently, the amount of residual food retained in it was reduced and pharyngeal clearance on the affected side was improved. The longest follow-up among the 3 patients has been 24 months. Their aspiration and glottal incompetence have been improved by this operation. We conclude that modified injection laryngoplasty (laryngohypopharyngoplasty) is one of the surgical options for preventing aspiration after vocal fold paralysis.     

DiHA (dextranomers in hyaluronan) injections for treatment of insufficient closure of the vocal folds: early clinical experiences

OBJECTIVE: To determine the clinical effects of injecting DiHA (a mixture of dextranomer molecules and 1% hyaluronan solution in equal proportions) as a "space filler" into the vocal folds of patients experiencing insufficient closure of the vocal folds resulting from either unilateral vocal fold paralysis or bowed vocal folds. STUDY DESIGN: A consecutive series of patients with insufficient closure of the vocal folds treated with DiHA injections and prospectively followed up with videostroboscopy and voice recordings that were evaluated by expert panels. METHODS: During a 21/2-year period, 14 patients with insufficient closure of the vocal folds were included. Six had a unilateral vocal fold palsy and 8 patients had "bowed" vocal folds. DiHA was injected into one vocal fold. Laryngoscopic examination and voice recordings were performed pre- and postoperatively. Expert panels did the evaluation of the stroboscopy examination and the perceptual voice analysis. RESULTS: Three patients were operated on with local and 11 under general anesthesia. All patients with unilateral palsy improved their stroboscopic status regarding both the wave and the closure after injection. Also, their voice parameters were significantly improved. Among the patients with bowed vocal folds, all except 2 showed an improvement in the glottic wave, 5 of 8 improved in glottic closure, and 3 improved their voice parameters significantly. CONCLUSION: This early clinical experience indicates that DiHA fulfills most of the requirements of an ideal "space-filling" substance for voice restoration in patients experiencing insufficient vocal fold closure.     

Voice outcome following thyroplasty in patients with cancer-related vocal fold paralysis

Medialization laryngoplasty restores voice in patients with unilateral laryngeal paralysis. Of question was whether patients with vocal fold paralysis resulting from cancer or its treatment had as good a post-operative voice result as patients with vocal fold paralysis of benign etiology. The purpose of the present study was to compare post-operative perceptual, acoustic, aerodynamic, and quality of life data in these two patient groups. Twenty-eight patients with vocal fold paralysis secondary to malignancy or its treatment were age and gender-matched with patients with paralysis resulting from benign origin. Pre- and post-operative perceptual judgments of pitch, loudness and quality were rated independently by two speech–language pathologists. A digital audiotape of the patient's voice was analyzed using Soundscope software. Fundamental frequency, conversational intensity and perturbation were evaluated. Glottal flow rates in propositional speech, phonation times and extent of pitch and loudness ranges were also measured. Three quality of life surveys, the Short Form-36 general health survey, the Voice Handicap Index, and the Voice Outcomes Study were administered. Results of voice testing indicated that perceptual, acoustic and aerodynamic data were significantly improved 3 months after thyroplasty in all patients regardless of whether they had a history of cancer. Quality of life data, however, distinguished the two groups. In particular, the general health measure found a significant difference in physical functioning and overall vitality, although satisfaction with improved voice was equally appreciated in both patient groups. Of clinical significance is that though general health may differ, patients with cancer-related laryngeal paralysis can expect to have as good a voice outcome following thyroplasty as patients with paralysis of benign etiology.     

Airway flow dynamics and voice acoustics after autologous fascia augmentation of paralyzed vocal fold

The aim of this study was to assess the effect of vocal fold medialization, accomplished by injection of autologous fascia, on airflow dynamics and voice acoustics. Ten patients with unilateral vocal fold paralysis were included. Flow-volume spirometry, body plethysmography, and acoustic analysis of voice were performed within 1 week before injection of autologous fascia and 4 to 14 months after operation. Medialization of the paralyzed vocal fold decreased the mean peak inspiratory flow (PIF) from 4.63 L to 4.10 L (p = .012). The acoustic characteristics of the voice improved: the values of jitter, shimmer, and mean noise-to-harmonics ratio decreased significantly (p = .006, p = .017, and p = .047, respectively), and the mean maximal phonation time almost doubled (p = .002). Changes in PIF and shimmer showed a negative correlation (r = -.857, p = .007). In conclusion, injection of autologous fascia improves voice acoustics, but induces a slight abnormal limitation on PIF. The results also suggest that improvement in voice acoustics is most prominent in subjects with the least deterioration in inspiratory airflow.     

A retrospective analysis of revision framework surgeries for unilateral vocal fold paralysis

IntroductionRevision framework surgeries might be required for unilateral vocal fold paralyses. However, outcomes and indications of revision surgeries have not been adequately documented. For a better understanding of indications for the procedure and to help in achieving better vocal outcomes, we performed a retrospective chart review of patients who underwent revision framework surgeries for unilateral vocal fold paralysis.ObjectivesThis study aimed to present clinical features of patients who underwent revision framework surgeries for the treatment of unilateral vocal fold paralysis.MethodsOf the 149 framework surgeries performed between October 2004 and October 2019, 21 revision framework surgeries were performed in 19 patients. Self-assessments by patients using the voice handicap index-10 questionnaire, and objective aerodynamic and acoustic assessments performed pre- and post-operatively were analyzed using the Wilcoxon’s signed-rank test for paired comparisons.ResultsUndercorrection was indicated as reasons for revision surgeries in all cases. The revision techniques included type I thyroplasty, type IV thyroplasty, and arytenoid adduction, and revision surgeries were completed without any severe complication in all cases. Pre- and post-operative voice handicap index-10 scores were obtained in 12 cases, and other parameters were evaluated in 18 cases. Significant improvements were observed in voice handicap index-10 scores, maximum phonation time, mean flow rate, Current/Direct Current ratio, and pitch perturbation quotient.ConclusionUndercorrection was observed in all patients who underwent revision framework surgeries for unilateral vocal fold paralysis, and the initial assessment and planning are thought to be important in order to avoid revision surgeries. Revision surgeries were performed safely in all cases, and significantly improved vocal outcomes were observed, even after multiple procedures. Revision surgery should be considered for patients with unsatisfactory vocal functions after primary framework surgeries for unilateral vocal fold paralysis.     

Functional assessment of posterior cordotomy in patients with bilateral vocal fold paralysis

Surgical treatment of bilateral vocal fold paralysis must be undertaken if such a condition lasts 6-12 months or longer and causes dyspnoea. The purpose of the procedures is to assure proper airflow through the glottis and to preserve good voice and unimpaired swallowing. Modern endoscopic surgery of the glottis is performed with CO2 laser. The following paper presents results of laser posterior cordotomy performed in 17 patients aged 19-73 years suffering from bilateral vocal fold paralysis. Results and conclusions: In 7 patients the range of vocal fold resection had to be expanded. 3 individuals developed post-operative granulation in subglottal region. Spirometry and electroglottography were performed before and after the operation to assess the patients' laryngeal functions: respiration and voice quality. The results indicate that laser cordectomy was effective in the discussed group of patients.     

Combined arytenoid adduction and laryngeal reinnervation in the treatment of vocal fold paralysis

OBJECTIVE/HYPOTHESIS: Glottal closure and symmetrical thyroarytenoid stiffness are two important functional characteristics of normal phonatory posture. In the treatment of unilateral vocal cord paralysis, vocal fold medialization improves closure, facilitating entrainment of both vocal folds for improved phonation, and reinnervation is purported to maintain vocal fold bulk and stiffness. A combination of medialization and reinnervation would be expected to further improve vocal quality over medialization alone. STUDY DESIGN: A retrospective review of preoperative and postoperative voice analysis on all patients who underwent arytenoid adduction alone (adduction group) or combined arytenoid adduction and ansa cervicalis to recurrent laryngeal nerve anastomosis (combined group) between 1989 and 1995 for the treatment of unilateral vocal cord paralysis. Patients without postoperative voice analysis were invited back for its completion. A perceptual analysis was designed and completed. METHODS: Videostroboscopic measures of glottal closure, mucosal wave, and symmetry were rated. Aerodynamic parameters of laryngeal airflow and subglottic pressure were measured. A 2-second segment of sustained vowel was used for perceptual analysis by means of a panel of voice professionals and a rating system. Statistical calculations were performed at a significance level of P = .05. RESULTS: There were 9 patients in the adduction group and 10 patients in the combined group. Closure and mucosal wave improved significantly in both groups. Airflow decreased in both groups, but the decrease reached statistical significance only in the adduction group. Subglottic pressure remained unchanged in both groups. Both groups had significant perceptual improvement of voice quality. In all tested parameters the extent of improvement was similar in both groups. CONCLUSION: The role of laryngeal reinnervation in the treatment of unilateral vocal cord paralysis remains to be established.     

Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer

Introduction

Patients with unilateral vocal fold paralysis may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach.

自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效观察

目的 探讨自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效.方法 对26例单 侧声带麻痹声门闭合不全患者全麻支撑喉镜下经口行声带内注射术,其中6例采用自体脂肪注射(A组),20例采用自体腹直肌前鞘筋膜加脂肪注射(B组).术前、术后动态喉镜检查和主客观嗓音分析评估疗效,均随访24个月.结果 两组患者术后注射物无外溢,注射侧声带形态饱满;术后3 d注射侧声带出现急性炎性反应,3个月左右消退.术后3个月A组所有患者注射侧声带回复至中线,声门闭合良好,6～24个月声门闭合稍有缝隙;B组所有患者术后6个月回复至中线,声门闭合良好,6～24个月声带形态稳定.术前嗓音声学分析:两组间基频微扰、振幅微扰、标准化噪声能量及最大发音时间差异无统计学意义(P值均＞0.05);A组术后3个月显著改善(P值均＜0.01),6及24个月较术前改善(P值＜0.05或＜0.01),但较术后3个月音质下降(P值＜0.05或＜0.01);B组术后6个月显著改善(P值均＜0.01),6、12及24个月各参数差异均无统计学意义(P值均＞0.05);术后24个月两组的基频微扰、标准化噪声能量及最大发音时间差异有统计学意义(P值＜0.05或＜0.01).B组嗓音听感知评估,总嘶哑度、气息声、发音无力程度评分降低,与术前相比差异有统计学意义(P值均＜0.01).结论 自体腹直肌前鞘筋膜加脂肪声带内注射术治疗单侧声带麻痹声门闭合不全可有效提高患者声音质量,远期效果稳定.

Abstract：

Objective To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. Methods A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold ( group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection ( group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. Results All patients were followed up for 24 months. On the third day after operation,there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later.In all 20 eases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant ( P ＜ 0. 01 ). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 -24 months after operation and were not changed by the length of follow-up. And in the 6 cases,videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P ＜ 0. 05 or ＜ 0. 01 ), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P ＜0. 05 or ＜0. 0l ). The significant differences were not observed between 6 and 24 months (P ＞ 0. 05 ). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months ( P ＜0. 05 or ＜ 0. 01 ). Conclusion The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.     

双声带楔形切除术治疗双侧声带外展麻痹

目的：探讨治疗双侧声带外展麻痹的微创外科手术方式——显微支撑喉镜下CO2激光双声带楔形切除术的临床应用价值。方法：使用显微支撑喉镜激光手术系统,治疗4例双侧声带外展麻痹患者。结果：3例经过1次手术,1例经过2次手术,随访5-36个月,患者呼吸困难完全缓解,能耐受日常生活活动;4例均对自己的声音较为满意,能进行日常的生活交流。结论：显微支撑喉镜CO2激光双侧声带楔形切除术,不需气管切开,术后喉功能恢复快,并发症少。既能解决患者通气的要求,又能保证发声的质量,本方法治疗双侧声带外展麻痹有很好的临床推广使用价值。     

Objective voice analysis after autologous fat injection for unilateral vocal fold paralysis

This study was designed to objectively compare a patient's voice after onset of unilateral vocal fold paralysis (UVFP) to his or her own normal voice, and to compare the results after treatment by intrafold injection of autologous fat. Acoustic recordings were obtained for 2 male patients before thoracic surgery and after the onset of iatrogenic left UVFP. Vocal fold augmentation was performed 10 days after UVFP. The acoustic recordings were repeated within 3 days and at 1 month. The phonation quotient, pitch perturbation quotient, amplitude perturbation quotient, harmonics-to-noise ratio, cepstral peak prominence, and long-term average spectrum were analyzed. All parameters improved after treatment, with a return to preparalytic values for most. During the first month, some deterioration was noted. This is the first study comparing a subject's own normal voice to his or her voice after vocal fold augmentation. We recommend overinjection of fat if vocal fold atrophy is expected.     

Correlation Between Vocal Functions and Glottal Measurements in Patients With Unilateral Vocal Fold Paralysis

Observations and analysis of glottal characteristics are critical in choosing the best modality for surgery in patients with unilateral vocal fold paralysis (UVP). This study suggests that multiple glottal characteristics influence the vocal product in patients with UVP. In addition to the horizontal position of the paralyzed vocal fold (deviation from the midline), the glottal area, degree of bowing of the paralyzed and contralateral vocal folds, maximum separation between vocal folds, compensatory glottal maneuvers, and the vertical glottic closure plane significantly influenced the quality of the voice. Clinicians should be aware of these observations to facilitate treatment planning and assessment of the results of surgical procedures used to improve voice quality in cases of UVP.     

Ansa cervicalis-to-recurrent laryngeal nerve anastomosis for unilateral vocal fold paralysis: experience of a single institution

OBJECTIVES: One treatment option for unilateral vocal fold paralysis (UVFP) is ansa cervicalis-to-recurrent laryngeal nerve (ansa-RLN) anastomosis to provide reinnervation to the affected vocal fold. The advantages of this treatment approach are that it 1) provides vocal fold tone, bulk, and tension, 2) is technically simple, and 3) does not preclude other medialization procedures. We present all patients who have undergone ansa-RLN anastomosis for UVFP at our institution. METHODS: An Institutional Review Board-approved retrospective chart review was performed to include all patients who had undergone an ansa-RLN anastomosis procedure for UVFP at our institution. Data from clinical and endoscopic laryngoscopy with stroboscopy were recorded. Statistical analysis was performed on visual and perceptual vocal data. RESULTS: A total of 46 patients were included in the study. Stroboscopic analysis and perceptual vocal evaluation was performed in a blinded fashion on the 21 patients who had preoperative and postoperative stroboscopy. Severity, roughness, breathiness, and strain all improved significantly over time. Glottic closure, vocal fold edge, and supraglottic effort all significantly improved after operation. Of the 38 patients with at least 3 months of follow-up, all except 1 demonstrated evidence of reinnervation. CONCLUSIONS: This technique for treating UVFP results in significant improvements in patients' voice and on visual examination.     

The role of laryngeal electromyography in the diagnosis of vocal fold immobility in children

INTRODUCTION: Pathology may affect the muscles that control vocal function directly by affecting peripheral function or indirectly by affecting the central nervous system. Clinically, muscle function can be assessed by observing the movements of the structures themselves or by recording the electrical activity of the muscles (electromyography, EMG). Since EMG is an invasive technique, it has enjoyed limited use in the diagnosis and management of voice disorders, especially in children. Laryngeal EMG may be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: The purpose of this paper is to study the role of laryngeal EMG in the clinical evaluation of unilateral vocal fold immobility in children. MATERIALS AND METHODS: Twenty-five children with unilateral vocal fold paralysis were studied. Twenty-five patients with vocal pathologies secondary to vocal abuse and misuse were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. Additionally, nine patients with traumatic arytenoid dislocation were also studied. All patients were subjected to laryngeal EMG. EMG showed a sensitivity of 100%, and specificity of 92%. Only two patients, present with a functional voice disorder, showed abnormalities in the EMG recordings. In the nine patients with arytenoid dislocation, EMG showed normal parameters. CONCLUSION: EMG seems a safe and reliable test for evaluating patients with vocal fold immobility. Moreover, the EMG recordings were helpful in differentiating vocal fold paralysis from arytenoid dislocation. EMG can provide useful data concerning muscle denervation, and more importantly, reinnervation. Besides its utility for the diagnosis, serial EMG can be useful for monitoring recovery and for establishing a reliable prognosis, and hence, an adequate treatment plan.     

Functional results after external vocal fold medialization thyroplasty with the titanium vocal fold medialization implant

OBJECTIVES/HYPOTHESIS: A persistent insufficiency of glottal closure is mostly a consequence of a unilateral vocal fold movement impairment. It can also be caused by vocal fold atrophy or scarring processes with regular bilateral respiratory vocal fold function. Because of consequential voice, breathing, and swallowing impairments, a functional surgical treatment is required. The goal of the study was to outline the functional results after medialization thyroplasty with the titanium vocal fold medialization implant according to Friedrich. METHODS: In the period of 1999 to 2001, an external vocal fold medialization using the titanium implant was performed on 28 patients (12 women and 16 men). The patients were in the age range of 19 to 84 years. Twenty-two patients had a paralysis of the left-side vocal fold, and six patients, of the right-side vocal fold. Detailed functional examinations were executed on all patients before and after the surgery: perceptive voice sound analysis according to the "roughness, breathiness, and hoarseness" method, judgment of the s/z ratio and voice dysfunction index, voice range profile measurements, videostroboscopy, and pulmonary function tests. In case of dysphagia/aspiration, videofluoroscopy of swallowing was also performed. The respective data were statistically analyzed (paired t test, Wilcoxon-test). RESULTS: All patients reported on improvement of voice, swallowing, and breathing functions postoperatively. Videostroboscopy revealed an almost complete glottal closure after surgery in all of the patients. All voice-related parameters showed a significant improvement. An increase of the laryngeal resistance by the medialization procedure could be excluded by analysis of the pulmonary function test. CONCLUSIONS: The results confirm the external medialization of the vocal folds as an adequate method in the therapy of voice, swallowing, and breathing impairment attributable to an insufficient glottal closure. The titanium implant offers, apart from good tissue tolerability, the advantage of an easy, time-saving, and individually adjustable application during the operation.