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Effect of injection augmentation on need for framework surgery in unilateral vocal fold paralysis.
Laryngoscope. 2016 Jan; 126(1):128-34.L

Abstract

OBJECTIVES/HYPOTHESIS

To determine whether injection augmentation reduces the likelihood of ultimately needing definitive framework surgery in unilateral vocal fold paralysis (UVFP) patients.

STUDY DESIGN

Retrospective cohort study.

METHODS

All patients diagnosed with UVFP (2008-2012) at the academic center were identified. The time from symptom onset to presentation to either community otolaryngologist and/or academic center, as well as any directed treatment(s), were recorded. Stepwise, multivariate logistic regression analysis was used to determine whether injection augmentation independently affected odds of needing definitive, framework surgery among patients who were seen within 9 months of symptom onset and had not undergone any prior rehabilitative procedures.

RESULTS

Cohort consisted of 633 patients (55% female, 80% Caucasian, median age 60 years) with UVFP. The majority of etiologies were either surgery (48%) or idiopathic (37%). Duration to presentation at community otolaryngologist was shorter than to the academic center (median 2 vs. 6 months). Overall, less than half of UVFP patients had any operation (46%). Multivariate logistic regression found that earlier injection augmentation did not affect odds of ultimately undergoing framework surgery (odds ratio 1.13; confidence interval, 0.92-1.40; P = 0.23).

CONCLUSION

Nearly half of UVFP patients do not require any rehabilitative procedure. When indicated, early injection augmentation is effective at temporarily alleviating associated symptoms but does not reduce likelihood of needing a definitive framework operation in patients with UVFP. Understanding practice patterns and fostering early detection and treatment may improve quality of life in this patient population.

Authors+Show Affiliations

Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. Center for Surgical Quality and Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A.Center for Surgical Quality and Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A. Geriatric Research Education and Clinical Center, Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, U.S.A.Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.Department of Otolaryngology, Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26153268

Citation

Francis, David O., et al. "Effect of Injection Augmentation On Need for Framework Surgery in Unilateral Vocal Fold Paralysis." The Laryngoscope, vol. 126, no. 1, 2016, pp. 128-34.
Francis DO, Williamson K, Hovis K, et al. Effect of injection augmentation on need for framework surgery in unilateral vocal fold paralysis. Laryngoscope. 2016;126(1):128-34.
Francis, D. O., Williamson, K., Hovis, K., Gelbard, A., Merati, A. L., Penson, D. F., Netterville, J. L., & Garrett, C. G. (2016). Effect of injection augmentation on need for framework surgery in unilateral vocal fold paralysis. The Laryngoscope, 126(1), 128-34. https://doi.org/10.1002/lary.25431
Francis DO, et al. Effect of Injection Augmentation On Need for Framework Surgery in Unilateral Vocal Fold Paralysis. Laryngoscope. 2016;126(1):128-34. PubMed PMID: 26153268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of injection augmentation on need for framework surgery in unilateral vocal fold paralysis. AU - Francis,David O, AU - Williamson,Kelly, AU - Hovis,Kristen, AU - Gelbard,Alexander, AU - Merati,Albert L, AU - Penson,David F, AU - Netterville,James L, AU - Garrett,C Gaelyn, Y1 - 2015/07/07/ PY - 2015/04/21/received PY - 2015/05/11/revised PY - 2015/05/18/accepted PY - 2015/7/9/entrez PY - 2015/7/15/pubmed PY - 2016/6/21/medline KW - Unilateral vocal fold paralysis KW - framework surgery KW - injection augmentation KW - injection laryngoplasty KW - selection bias KW - time to presentation KW - type I laryngoplasty SP - 128 EP - 34 JF - The Laryngoscope JO - Laryngoscope VL - 126 IS - 1 N2 - OBJECTIVES/HYPOTHESIS: To determine whether injection augmentation reduces the likelihood of ultimately needing definitive framework surgery in unilateral vocal fold paralysis (UVFP) patients. STUDY DESIGN: Retrospective cohort study. METHODS: All patients diagnosed with UVFP (2008-2012) at the academic center were identified. The time from symptom onset to presentation to either community otolaryngologist and/or academic center, as well as any directed treatment(s), were recorded. Stepwise, multivariate logistic regression analysis was used to determine whether injection augmentation independently affected odds of needing definitive, framework surgery among patients who were seen within 9 months of symptom onset and had not undergone any prior rehabilitative procedures. RESULTS: Cohort consisted of 633 patients (55% female, 80% Caucasian, median age 60 years) with UVFP. The majority of etiologies were either surgery (48%) or idiopathic (37%). Duration to presentation at community otolaryngologist was shorter than to the academic center (median 2 vs. 6 months). Overall, less than half of UVFP patients had any operation (46%). Multivariate logistic regression found that earlier injection augmentation did not affect odds of ultimately undergoing framework surgery (odds ratio 1.13; confidence interval, 0.92-1.40; P = 0.23). CONCLUSION: Nearly half of UVFP patients do not require any rehabilitative procedure. When indicated, early injection augmentation is effective at temporarily alleviating associated symptoms but does not reduce likelihood of needing a definitive framework operation in patients with UVFP. Understanding practice patterns and fostering early detection and treatment may improve quality of life in this patient population. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/26153268/Effect_of_injection_augmentation_on_need_for_framework_surgery_in_unilateral_vocal_fold_paralysis_ L2 - https://doi.org/10.1002/lary.25431 DB - PRIME DP - Unbound Medicine ER -