Voice gains following thyroplasty may improve over time1

Type I thyroplasty for unilateral vocal fold paralysis restores voice. The purpose of this study was to evaluate measures of voice before thyroplasty, and at 3 months and 1 year after surgery. Of interest was whether vocal improvement in the first weeks after surgery was maintained or even enhanced over time. A total of 40 patients with unilateral paralysis underwent type I thyroplasty with or without arytenoid adduction. Perceptual, acoustic and aerodynamic measures of voice were studied. Perceptual analysis determined that optimal postoperative voice quality evolved over the first year. Acoustic indices of perturbation demonstrated progressive improvement over 12 months, whereas pitch and intensity ranges were increasingly extended. Postoperative glottal flow rates were normalized and phonation times were significantly longer, with benefits maintained over time. All perceptual, aerodynamic and acoustic measures of voice were improved 3 months after thyroplasty, with many measures further improved at 1 year. Such findings provide evidence that voice outcome progressively evolves over the first 12 months after surgery.     

Laryngeal Collagen Injection as an Adjunct to Medialization Laryngoplasty

Objectives/Hypothesis Dysphonia associated with laryngeal paralysis may be identified in the short term postoperatively or may develop years after successful medialization laryngoplasty. In selected cases, laryngeal collagen injection permits further medialization of one or both vocal folds by small increments to improve phonation after medialization thyroplasty. The study seeks to determine whether collagen injections result in measurable improvements in voice quality and vocal function when offered to select patients who have received medialization thyroplasty. Study Design Retrospective review of patient charts and voice database. Methods Seven patients were treated with Zyderm II collagen using indirect mirror laryngoscopy and a curved injection apparatus. Changes in voice quality and function were assessed by comparing measures obtained before treatment (mean period, 5.6 d), shortly after treatment (mean period, 38.1 d), and in the long term after treatment (mean period, 226 d). Results Mean self‐ratings of the patient, clinician's ratings, and objective measures demonstrated measurable improvement in vocal function after collagen injection. Conclusions The office‐based procedure offers a simple, efficient adjunct to open techniques of medialization laryngoplasty. Techniques of anesthesia, injection, and patient selection are discussed.     

Medialization thyroplasty window creation using an ultrasonic surgical aspirator

OBJECTIVES/HYPOTHESIS: The aim of the study was to investigate the use of an ultrasonic surgical aspirator for creation of the laryngeal cartilage window during medialization thyroplasty. STUDY DESIGN: Basic science. METHODS: Forty thyroplasty windows were constructed in fresh, unpreserved cadaver larynges. A 6 x 13-mm rectangular window and a 4 x 4-mm round window were created on each side of the larynges in a symmetrical fashion. A standard surgical drill with a 3-mm cutting burr was used on one side; the ultrasonic surgical aspirator was used on the contralateral side. The time required for window construction was recorded, as was the status of the inner perichondrium at window completion. RESULTS: For creation of the 6 x 13-mm window, a mean time of 128 seconds was required using a standard surgical drill. The mean time using the ultrasonic aspirator device was 91 seconds for the window of the same size (P < .008). For the 4-mm round window, drilling completed the task in a mean time of 63 seconds, compared with 40 seconds (P < .016) for the ultrasonic aspirator. On creation of the 6 x 13-mm window, there were 4 of 10 perichondrial violations in the drilled specimens, and there were no violations in creation of the window of the same size with the ultrasonic aspirator (P = .12). The 4-mm round window had no perichondrium violations in the standard drill group and only 1 of 10 violations in the ultrasonic aspirator group (P = .99). CONCLUSION: The study suggested that the ultrasonic surgical aspirator device may be an effective, efficient alternative to the standard drill for medialization thyroplasty window creation. Prospective clinical trials are warranted to better characterize its applicability.     

Thyroplasty type I without arytenoid adduction in patients with unilateral laryngeal nerve paralysis: the montgomery implant versus the Gore-Tex implant

Objective The current series was designed to compare the results achieved with the Montgomery and Gore-Tex implants in thyroplasty type I without arytenoid adduction in patients with unilateral laryngeal nerve paralysis.

Material and Methods An inception cohort of 57 French language speakers with unilateral laryngeal nerve paralysis were managed with thyroplasty type I using Gore-Tex (Group GT; n=24) or Montgomery (Group M; n=33) implants. The two groups had similar patient characteristics. Morbidity, phonatory results according to self assessment by the patient and selected speech and voice parameters (fundamental frequency, jitter, shimmer, noise:harmonic ratio, phonation time, phrase grouping and speech rate) were analyzed 1 month postoperatively in both groups.

Results Dyspnea, as noted in three patients, was the only immediate complication. Late complications included persistent inflammation of the vocal cord after insertion of a Gore-Tex implant, endolaryngeal extrusion of the Gore-Tex implant and dislodgment of the Montgomery implant in one patient each. Postoperatively, all patients reported improvements in speech and voice. Secondary degradation of speech and voice was noted in one patient in each group. Comparison of selected speech and voice parameters at 1 month postoperatively showed (i) a statistically significant (p<0.01) decrease in the jitter, shimmer and noise:harmonic ratio values and (ii) a statistically significant (p<0.01) increase in the speech rate values in Group M compared to Group GT patients. Also, a trend (0.05<p<0.1) was noted towards an increase in the phrase grouping values in Group M compared to Group GT patients.

Conclusions Although limitations exist in the interpretation of the reported data, our results suggest that in patients with unilateral laryngeal nerve paralysis managed with a thyroplasty type I technique without arytenoid adduction, the use of a Montgomery compared to a Gore-Tex implant does not influence the success of the procedure according to the patient's self evaluation or the morbidity but does lead to a significant improvement in the values of selected speech and voice parameters.