Aerodynamic and Acoustic Characteristics of Voice Before and After Adduction Arytenopexy and Medialization Laryngoplasty with GORE-TEX in Patients with Unilateral Vocal Fold Immobility

Abstract

Multiple surgical techniques have been developed to restore function in patients with vocal fold paralysis (VFP), ranging from open laryngeal framework procedures to endoscopic injection techniques. In our experience, adduction arytenopexy (AA) and medialization laryngoplasty with GORE-TEX (MLG), with or without cricothyroid subluxation (CTS), together offer patients optimal improvement in voice, based on the subjective change in voice quality and patient feedback obtained. In this study, we analyze objective voice parameters in these patients before and after surgery. The objective of this retrospective chart review is to demonstrate the change in aerodynamic and acoustic properties of voice in patients with VFP who undergo combined AA and MLG, with or without CTS. Seventy-five patients underwent combined AA and MLG between May 2001 and September 2006; 28 completed both preoperative and postoperative voice evaluation including aerodynamic and acoustic testing. Retrospective chart review is used to compare pre- and postoperative voice parameters in these patients. Statistically significant increases in mean maximum phonation time (MPT) and mean intensity of "/pae/" during aerodynamic testing, with a statistically significant decrease in mean glottal airflow were observed. A notable increase in mean glottal resistance was not statistically significant. No significant change was observed in the other parameters tested. Mean MPT increased and mean glottal airflow decreased. These objective results correlate with patients' subjective improvement. However, while "objective," acoustic and aerodynamic testing are effort dependent, and thus may not be as reliable as other tools in measuring postsurgical voice outcomes. Patient surveys may be the best means of gauging surgical success.