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Arytenoid vertical height discrepancy in predicting outcomes after unilateral vocal cord medialization.
Laryngoscope. 2020 02; 130(2):418-422.L

Abstract

OBJECTIVES/HYPOTHESIS

Unilateral vocal fold paralysis is a structural abnormality that often occurs secondary to dysfunction of the recurrent laryngeal nerve and typically presents as a breathy voice. Medialization laryngoplasty is a constellation of procedures that improves apposition of the vocal cords. Many patients, however, fail to experience sufficient improvement in vocal quality postoperatively despite apparent glottic closure on stroboscopy. This suggests that asymmetry in other cord characteristics may also have acoustic consequences. Our hypothesis is that arytenoid height symmetry may play a significant role in vocal quality. To our knowledge there are no human observational studies examining this topic. We therefore aimed to correlate asymmetry in arytenoid height and patient-reported satisfaction in voice quality after thyroplasty.

STUDY DESIGN

Retrospective cohort analysis.

METHODS

A retrospective review of prospectively collected data on consecutive patients who underwent medialization thyroplasty at a tertiary Sydney, Australia hospital was performed. Data collected included age, sex, onset of symptoms, as well as well as preoperative and 3-month postoperative maximum phonation time and Voice Handicap Index (VHI). Preoperative computed tomography scans were assessed for discrepancy of arytenoid vertical height discrepancy.

RESULTS

Twenty-three patients (56.5% female) with mean age of 52.4 ± 14.9 years were included. Most patients underwent injection thyroplasty (78.3%, n = 5), whereas the remaining underwent an open approach. A statistically significant inverse correlation was found between increasing height discrepancy and VHI improvement (r = -0.6, P = .003.) Revision surgery was associated with increased height discrepancy.

CONCLUSIONS

Findings of this study may affect future recommendations to address height discrepancy in surgery to treat unilateral vocal cord paralysis.

LEVEL OF EVIDENCE

3 Laryngoscope, 130:418-422, 2020.

Authors+Show Affiliations

Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia. Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia.Department of Speech Pathology, Westmead Hospital, Westmead, New South Wales, Australia.Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia. Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia. Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia. Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30843620

Citation

Wong, Eugene, et al. "Arytenoid Vertical Height Discrepancy in Predicting Outcomes After Unilateral Vocal Cord Medialization." The Laryngoscope, vol. 130, no. 2, 2020, pp. 418-422.
Wong E, Smith M, Stone DB, et al. Arytenoid vertical height discrepancy in predicting outcomes after unilateral vocal cord medialization. Laryngoscope. 2020;130(2):418-422.
Wong, E., Smith, M., Stone, D. B., Palme, C. E., Smith, M. C., & Riffat, F. (2020). Arytenoid vertical height discrepancy in predicting outcomes after unilateral vocal cord medialization. The Laryngoscope, 130(2), 418-422. https://doi.org/10.1002/lary.27900
Wong E, et al. Arytenoid Vertical Height Discrepancy in Predicting Outcomes After Unilateral Vocal Cord Medialization. Laryngoscope. 2020;130(2):418-422. PubMed PMID: 30843620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arytenoid vertical height discrepancy in predicting outcomes after unilateral vocal cord medialization. AU - Wong,Eugene, AU - Smith,Murray, AU - Stone,Danielle B, AU - Palme,Carsten E, AU - Smith,Mark C, AU - Riffat,Faruque, Y1 - 2019/03/07/ PY - 2018/11/28/received PY - 2019/01/09/revised PY - 2019/02/12/accepted PY - 2019/3/8/pubmed PY - 2020/7/28/medline PY - 2019/3/8/entrez KW - Vocal cord KW - height KW - palsy KW - thyroplasty KW - voice SP - 418 EP - 422 JF - The Laryngoscope JO - Laryngoscope VL - 130 IS - 2 N2 - OBJECTIVES/HYPOTHESIS: Unilateral vocal fold paralysis is a structural abnormality that often occurs secondary to dysfunction of the recurrent laryngeal nerve and typically presents as a breathy voice. Medialization laryngoplasty is a constellation of procedures that improves apposition of the vocal cords. Many patients, however, fail to experience sufficient improvement in vocal quality postoperatively despite apparent glottic closure on stroboscopy. This suggests that asymmetry in other cord characteristics may also have acoustic consequences. Our hypothesis is that arytenoid height symmetry may play a significant role in vocal quality. To our knowledge there are no human observational studies examining this topic. We therefore aimed to correlate asymmetry in arytenoid height and patient-reported satisfaction in voice quality after thyroplasty. STUDY DESIGN: Retrospective cohort analysis. METHODS: A retrospective review of prospectively collected data on consecutive patients who underwent medialization thyroplasty at a tertiary Sydney, Australia hospital was performed. Data collected included age, sex, onset of symptoms, as well as well as preoperative and 3-month postoperative maximum phonation time and Voice Handicap Index (VHI). Preoperative computed tomography scans were assessed for discrepancy of arytenoid vertical height discrepancy. RESULTS: Twenty-three patients (56.5% female) with mean age of 52.4 ± 14.9 years were included. Most patients underwent injection thyroplasty (78.3%, n = 5), whereas the remaining underwent an open approach. A statistically significant inverse correlation was found between increasing height discrepancy and VHI improvement (r = -0.6, P = .003.) Revision surgery was associated with increased height discrepancy. CONCLUSIONS: Findings of this study may affect future recommendations to address height discrepancy in surgery to treat unilateral vocal cord paralysis. LEVEL OF EVIDENCE: 3 Laryngoscope, 130:418-422, 2020. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/30843620/Arytenoid_vertical_height_discrepancy_in_predicting_outcomes_after_unilateral_vocal_cord_medialization_ L2 - https://doi.org/10.1002/lary.27900 DB - PRIME DP - Unbound Medicine ER -