Influence of preoperative voice assessment on treatment plan prior to airway surgery

Bergeron, Mathieu; Kelchner, Lisa; Weinrich, Barbara; Brehm, Susan Baker; Zacharias, Stephanie; Myer, Charles M.; Alarcón, Alessandro de

doi:10.1002/lary.27402

Cited by 11 publications

(9 citation statements)

References 21 publications

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“…Patients with shortness of breath and history of tracheostomy should increase the awareness of the possibly of an A‐frame deformity. As with other sites of airway obstructions, carefully planning is required 11–20 …”

Section: Discussionmentioning

confidence: 99%

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

et al. 2020

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Objectives Tracheal A‐frame deformity is a known consequence of tracheostomy that may lead to obstruction after decannulation. The goal of this study is to demonstrate the feasibility and success of endoscopic carbon dioxide (CO2) laser‐assisted tracheoplasty of tracheal A‐frame deformity in children. Methods Retrospective case series of symptomatic children with tracheal A‐frame deformity with no other site of airway obstruction (2016–2018). All patients underwent CO2‐laser assisted endoscopic resection tracheoplasty. Results Eight patients (six male) were included with a median age of 15.4 (IQR 12.3–17.9) years. Patients had a median of two previous open airway surgeries (IQR 1–2.5) and all patients had a history of tracheostomy with successful decannulation. Tracheal A‐frame deformity presented as dyspnea on exertion for all patients (n = 8, 100%). Obstructive sleep apnea was confirmed for all patients who underwent polysomnography (4/4, 100%). Median interval from decannulation to development of symptoms was 8.7 years (IQR 5.8–9.3). All patients sized with an age‐appropriate endotracheal tube despite the deformity. Endoscopic A‐frame tracheoplasty was successful for 7/8 (87.5%) patients and was performed with overnight observation for these patients (8/8, 100%). Unilateral A‐frame tracheoplasty was performed successfully for five patients (62.5%), bilateral A‐frame tracheoplasty was performed successfully for two patients (25.0%), and one patient (12.5%) did not have complete resolution of symptoms after bilateral A‐frame tracheoplasty due to multi‐level airway obstruction. Conclusions CO2 laser‐assisted tracheoplasty is an innovative endoscopic technique to relieve symptoms of airway obstruction for selected patients with tracheal A‐frame deformity although avoiding the morbidity and hospital stay duration associated with tracheal resection. Level of Evidence 4 Laryngoscope, 131:E719–E723, 2021

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Section: Discussionmentioning

confidence: 99%

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

et al. 2020

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“…However, the clinical impact of DVCT on patient outcomes has not been investigated. 22 Given the potential for anatomic and physiologic changes following airway reconstruction and possible difficulty of a complete assessment with the NP scope, a better understanding of laryngeal mobility and postsurgical changes would be beneficial for future voice surgeries. We hypothesized that performing a DVCT prior voice surgery would tailor voice surgery and also improve voice outcomes, as evaluated by the pediatric Voice Handicap Index (pVHI) and the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).…”

Section: Introductionmentioning

confidence: 99%

The Value of Dynamic Voice CT Scan for Complex Airway Patients Undergoing Voice Surgery

Bergeron

Fleck

Zacharias

et al. 2019

Ann Otol Rhinol Laryngol

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Introduction: Dynamic voice computerized tomography (DVCT) is a novel technique that provides additional information to characterize laryngeal function for patients with complex airway history that may alter surgical decisions. The goal of this study was to evaluate the impact of DVCT on decision making for reconstructive voice surgery for a cohort of post-airway reconstruction dysphonia patients. Methods: Retrospective chart review at a pediatric tertiary care center for patients with history of complex airway surgery and subsequent reconstructive voice surgery for dysphonia between 2010 and 2016. The study group had a DVCT prior to surgery while the control group underwent surgery without a DVCT. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and pediatric Voice Handicap Index (pVHI) scores were evaluated by the voice clinic team (otolaryngologist, speech therapist) before and after voice surgery. Results: Twenty-one patients were analyzed (14 female, 67%) with a mean age (SD) of 14 (4.5) years old. Ninety percent (17/21) had a prior tracheostomy and a mean (SD) of 2.6 (1.3) airway surgeries. Twelve patients (57%) underwent DVCT prior to reconstructive voice surgery. CAPE-V baseline scores were similar between study and controls (means [SE] = 49 [4.6] and 57 [6.0], P = .72). However, scores significantly improved for the study group after voice surgery (mean [SE] = 31 (4.7), P < .0001) while controls did not improve (58 [5.7], P = .99). Baseline VHI scores were similar between both groups: mean (SE) = 54 (5.4) versus 52 (6.2), respectively, P = .99. Postsurgically, VHI scores were also similar between both groups (means [SE]: 46 [7.1] vs 47 [4.5], P = .99). Reconstructive voice surgery for study patients included posterior cricoid reduction (46%), vocal fold medialization/augmentation (46%), and laryngeal reinnervation (7.7%) while all controls underwent a single treatment (vocal fold medialization/augmentation). Conclusion: Patients with preoperative DVCT were more likely to have improvement. DVCT appeared to have altered surgical decision making and has allowed tailoring of reconstructive surgery to specific patients’ needs. DVCT could represent an important tool prior to reconstructive surgery to guide the choice of surgical procedures for complex airway patients.

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“…Voice evaluation provides further crucial, detailed functional information that can specifically direct the management of ongoing airway and voice problems. [11][12][13] Given complex medical history, management of PARD should prioritize minimally invasive procedures both to protect airway improvements gained and to minimize comorbidity of voice surgical interventions. Vocal fold injection augmentation (VFIA) has proven to improve voice quality and reduced mean airflow rates in several group of patients.…”

Section: Introductionmentioning

confidence: 99%

Vocal Fold Injection Augmentation for Post-Airway Reconstruction Dysphonia: A Case Series

Bergeron

Giliberto

Tabangin

et al. 2021

Ann Otol Rhinol Laryngol

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Objectives: Post airway reconstruction dysphonia (PARD) is common and has a significant effect on the quality of life of patients. Vocal fold injection augmentation (VFIA) is one treatment that can be used to improve glottic insufficiency in some patients. The goal of this study was to characterize the use and outcomes of VFIA for PARD. Methods: Retrospective chart review from January 2007 to July 2018 at a tertiary pediatric care center. Consecutive patients with PARD who underwent VFIA, who had a preoperative voice evaluation and a follow-up evaluation within 3 months after VFIA (fat, carboxymethylcellulose gel, hyaluronic acid). Results: Thirty-four patients (20 female) underwent VFIA. The mean age at the time of the injection was 13.6 years (SD 6.1). Twenty patients (58.8%) had a history of prematurity and a mean of 1.8 open airway surgeries. After injection, 29/34 patients (85.3%) noted a subjective voice improvement. The baseline Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) overall severity score decreased by a mean of 5.7 (SD = 19.6) points, P = .12. Total pediatric Voice Handicap Index (pVHI) improved by 6.0 (SD = 19.5) points, from 57.4 (SD = 20.0) to 51.4 (SD = 17.2), P = .09. Functional pVHI subscore demonstrated a significant improvement, with a decrease of 3.4 (SD = 7.3) points, P = .02. All procedures were performed as an overnight observation and no complication occurred. Conclusion: Patients with PARD represent a complex subset of patients. VFIA is a straightforward intervention that may improve voice perception. Many patients reported subjective improvement despite minimal objective measurement. Further work is warranted to elucidate the role of injection in management of PARD

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Influence of preoperative voice assessment on treatment plan prior to airway surgery

Abstract: 4 Laryngoscope, 2018.

Cited by 11 publications

References 21 publications

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

The Value of Dynamic Voice CT Scan for Complex Airway Patients Undergoing Voice Surgery

Vocal Fold Injection Augmentation for Post-Airway Reconstruction Dysphonia: A Case Series

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