Voice outcomes following medialization laryngoplasty with and without arytenoid adduction

Abstract

Objective Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA). Methods Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009–2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index‐10 (VHI‐10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE‐V) were assessed. Results Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI‐10 scores (P < 0.001), and CAPE‐V scores (P = 0.007). Baseline VHI‐10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI‐10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE‐V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates. Conclusion Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA. Level of Evidence 4 Laryngoscope, 129:1876–1881, 2019

Managing Otolaryngologic Complications in Cardiothoracic Surgery

“…16,17 Other studies have suggested improved outcomes when arytenoid adduction is added to thyroplasty, although patients who required arytenoid adduction had poorer voice outcomes preoperatively. 18 Swallow outcomes also improve after thyroplasty, with or without arytenoid adduction. 19 As noted earlier, anatomic reduction the glottic gap can reduce the risk of aspiration.…”

Type I Thyroplasty Using a Titanium Implant Combined With Modified Arytenoid Adduction

“…The present author has developed the “titanium medialization laryngoplasty implant” (TMLI) (patent number in Japan: 6434921) and reported on its usability 7 . Further, a number of modifications to AA, along with the surgical indications, have also been reported 8–11 . The present author also developed and proved the clinical utility of the “all muscles preserved method” (AMPM) 12 …”

“…7 Further, a number of modifications to AA, along with the surgical indications, have also been reported. [8][9][10][11] The present author also developed and proved the clinical utility of the "all muscles preserved method" (AMPM). 12 This study aims to present and discuss the results associated with a combined surgical approach of the above-mentioned methods to treat patients with severe breathy hoarseness.…”

A narrative review of current therapies in unilateral recurrent laryngeal nerve injury caused by thyroid surgery

“…AA plays a part in UVCP treatment by directly stretching arytenoid cartilage directly. AA is usually adjuvant medialization procedures (46)(47)(48). A novel endoscopic AA with IL was developed as a rapid, minimally invasive solution for UVFP (49).…”