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Arytenoid adduction with nerve-muscle pedicle transfer vs arytenoid adduction with and without type I thyroplasty in paralytic dysphonia.
JAMA Otolaryngol Head Neck Surg. 2014 Sep; 140(9):833-9.JO

Abstract

IMPORTANCE

Optimal glottal closure as well as symmetrical vocal fold masses and tensions are essential prerequisites for normal voice production. Successful phonosurgery depends on restoring these prerequisites to achieve long-term improvement.

OBJECTIVE

To evaluate the efficacy of the laryngeal framework surgical treatments (arytenoid adduction with and without thyroplasty type I [AA ± Th-I]) compared with arytenoid adduction combined with nerve-muscle pedicle flap transfer (AA + NMP) in unilateral vocal fold paralysis. Patterns of voice outcome were compared over a 2-year period.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective review of clinical records of 22 patients who presented to an institutional practice with severe paralytic dysphonia between March 1999 and December 2008, who received 2 different treatments. Postoperative follow-up was conducted over 2 years.

INTERVENTIONS

Eleven patients were treated with AA ± Th-I and 11 patients were treated with AA + NMP.

MAIN OUTCOMES AND MEASURES

Vocal function was evaluated preoperatively and at 3, 12, and 24 months postoperatively. Vocal parameters evaluated were jitter, shimmer, harmonics to noise ratio (HNR), maximum phonation time (MPT), and overall grade and breathiness grade of the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) voice scale. The outcomes of voice measurements were compared within each group across time and among the 2 groups at each time point.

RESULTS

All voice parameters showed initial postoperative improvement in both groups after 3 months. Moreover, the AA + NMP group showed significant steady improvement over the 2-year follow-up, which did not occur in the AA ± Th-I group. In the AA + NMP group, MPT increased from a mean (SD) of 5.4 (2.1) s at preoperative assessment to 21.5 (7.0) s at 24 months; jitter decreased from 8.6% (5.3%) to 1.2% (0.7%); shimmer decreased from 13.1% (6.0%) to 4.0% (1.6%); HNR increased from 3.8 (3.3) to 9.0 (0.8); overall grade of GRBAS decreased from 2.4 (0.9) to 0.2 (0.4); and breathiness grade of GRBAS decreased from 2.0 (1.0) to 0.1 (0.3).

CONCLUSIONS AND RELEVANCE

Unlike the conventional laryngeal framework surgical treatments, AA + NMP provided long-term voice improvement with nearly normal voice quality. Thus, it can be considered an effective surgical treatment for paralytic dysphonia due to unilateral vocal fold paralysis associated with large glottal gap.

Authors+Show Affiliations

Phoniatrics Unit, Sohag University, Sohag, Egypt2Department of Otolaryngology, Sohag University, Sohag, Egypt3Faculty of Medicine, Sohag University, Sohag, Egypt.Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine Kumamoto University, Kumamoto City, Japan.Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine Kumamoto University, Kumamoto City, Japan.Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine Kumamoto University, Kumamoto City, Japan.Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine Kumamoto University, Kumamoto City, Japan.Phoniatrics Unit, Ain Shams University, Cairo, Egypt6Department of Otolaryngology, Ain Shams University, Cairo, Egypt7Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Otolaryngology, Ain Shams University, Cairo, Egypt7Faculty of Medicine, Ain Shams University, Cairo, Egypt.Phoniatrics Unit, Ain Shams University, Cairo, Egypt6Department of Otolaryngology, Ain Shams University, Cairo, Egypt7Faculty of Medicine, Ain Shams University, Cairo, Egypt.Phoniatrics Unit, Sohag University, Sohag, Egypt2Department of Otolaryngology, Sohag University, Sohag, Egypt3Faculty of Medicine, Sohag University, Sohag, Egypt.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25123168

Citation

Hassan, Megahed M., et al. "Arytenoid Adduction With Nerve-muscle Pedicle Transfer Vs Arytenoid Adduction With and Without Type I Thyroplasty in Paralytic Dysphonia." JAMA Otolaryngology-- Head & Neck Surgery, vol. 140, no. 9, 2014, pp. 833-9.
Hassan MM, Yumoto E, Sanuki T, et al. Arytenoid adduction with nerve-muscle pedicle transfer vs arytenoid adduction with and without type I thyroplasty in paralytic dysphonia. JAMA Otolaryngol Head Neck Surg. 2014;140(9):833-9.
Hassan, M. M., Yumoto, E., Sanuki, T., Kumai, Y., Kodama, N., Baraka, M. A., Wahba, H., Hafez, N. G., & El-Adawy, A. A. (2014). Arytenoid adduction with nerve-muscle pedicle transfer vs arytenoid adduction with and without type I thyroplasty in paralytic dysphonia. JAMA Otolaryngology-- Head & Neck Surgery, 140(9), 833-9. https://doi.org/10.1001/jamaoto.2014.1444
Hassan MM, et al. Arytenoid Adduction With Nerve-muscle Pedicle Transfer Vs Arytenoid Adduction With and Without Type I Thyroplasty in Paralytic Dysphonia. JAMA Otolaryngol Head Neck Surg. 2014;140(9):833-9. PubMed PMID: 25123168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arytenoid adduction with nerve-muscle pedicle transfer vs arytenoid adduction with and without type I thyroplasty in paralytic dysphonia. AU - Hassan,Megahed M, AU - Yumoto,Eiji, AU - Sanuki,Tetsuji, AU - Kumai,Yoshihiko, AU - Kodama,Narihiro, AU - Baraka,M Ali, AU - Wahba,Hassan, AU - Hafez,Nervana G, AU - El-Adawy,Ahlam A N, PY - 2014/8/16/entrez PY - 2014/8/16/pubmed PY - 2014/11/18/medline SP - 833 EP - 9 JF - JAMA otolaryngology-- head & neck surgery JO - JAMA Otolaryngol Head Neck Surg VL - 140 IS - 9 N2 - IMPORTANCE: Optimal glottal closure as well as symmetrical vocal fold masses and tensions are essential prerequisites for normal voice production. Successful phonosurgery depends on restoring these prerequisites to achieve long-term improvement. OBJECTIVE: To evaluate the efficacy of the laryngeal framework surgical treatments (arytenoid adduction with and without thyroplasty type I [AA ± Th-I]) compared with arytenoid adduction combined with nerve-muscle pedicle flap transfer (AA + NMP) in unilateral vocal fold paralysis. Patterns of voice outcome were compared over a 2-year period. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of clinical records of 22 patients who presented to an institutional practice with severe paralytic dysphonia between March 1999 and December 2008, who received 2 different treatments. Postoperative follow-up was conducted over 2 years. INTERVENTIONS: Eleven patients were treated with AA ± Th-I and 11 patients were treated with AA + NMP. MAIN OUTCOMES AND MEASURES: Vocal function was evaluated preoperatively and at 3, 12, and 24 months postoperatively. Vocal parameters evaluated were jitter, shimmer, harmonics to noise ratio (HNR), maximum phonation time (MPT), and overall grade and breathiness grade of the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) voice scale. The outcomes of voice measurements were compared within each group across time and among the 2 groups at each time point. RESULTS: All voice parameters showed initial postoperative improvement in both groups after 3 months. Moreover, the AA + NMP group showed significant steady improvement over the 2-year follow-up, which did not occur in the AA ± Th-I group. In the AA + NMP group, MPT increased from a mean (SD) of 5.4 (2.1) s at preoperative assessment to 21.5 (7.0) s at 24 months; jitter decreased from 8.6% (5.3%) to 1.2% (0.7%); shimmer decreased from 13.1% (6.0%) to 4.0% (1.6%); HNR increased from 3.8 (3.3) to 9.0 (0.8); overall grade of GRBAS decreased from 2.4 (0.9) to 0.2 (0.4); and breathiness grade of GRBAS decreased from 2.0 (1.0) to 0.1 (0.3). CONCLUSIONS AND RELEVANCE: Unlike the conventional laryngeal framework surgical treatments, AA + NMP provided long-term voice improvement with nearly normal voice quality. Thus, it can be considered an effective surgical treatment for paralytic dysphonia due to unilateral vocal fold paralysis associated with large glottal gap. SN - 2168-619X UR - https://www.unboundmedicine.com/medline/citation/25123168/Arytenoid_adduction_with_nerve_muscle_pedicle_transfer_vs_arytenoid_adduction_with_and_without_type_I_thyroplasty_in_paralytic_dysphonia_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2014.1444 DB - PRIME DP - Unbound Medicine ER -