Arytenoid adduction with medialization laryngoplasty versus injection or medialization laryngoplasty: The role of the arytenoidopexy

Abstract

There continues to be controversy about the added role of arytenoid adduction (AA) in the rehabilitation of unilateral vocal cord paralysis (UVCP). Some authors feel that the added morbidity of AA is not warranted in UVCP rehabilitation. Objective analysis of acoustic and aerodynamic measures were performed before and after surgery to try to resolve this controversy. This is an institutional review board-approved retrospective study of 85 patients with UVCP undergoing surgical rehabilitation by injection laryngoplasty (n = 45), medialization laryngoplasty (n = 14), or medialization laryngoplasty with arytenoid adduction (n = 26). Acoustic and aerodynamic parameters were studied before and after surgery. The medialization laryngoplasty (ML) group (medialization alone, injection laryngoplasty ML/IL) data were compared to the AA-ML group using a paired t test for the individual measures and analysis of variance (ANOVA) for the multivariate analysis of acoustic and aerodynamic measures. In all treatment arms there were statistically significant improvements in all acoustic and aerodynamic measures after intervention (P < .05). For ML and IL, the mean difference between preoperative from postoperative jitter was 1.504%, shimmer 3.265%, noise to harmonic ratio (NHR) 0.036, mean phonation time 4.523 seconds, transglottic flow 0.130 L/s, and subglottic pressure 0.616 cm H2O. For AA-ML the mean difference between preoperative and postoperative jitter was 2.431%, shimmer 6.068%, NHR 0.082, mean phonation time 6.74 seconds, flow 0.181 L/s, and subglottic pressure 0.611 cm H2. Preoperatively, the average phonatory function of the AA-ML group was worse than the ML group. Comparison between the two treatment arms, individual acoustic and aerodynamic measures, were not different (paired t test, P < .05). However, mulitvariate analysis (ANOVA, P < .05) of acoustic and aerodynamic measures, showed a statistically significant difference between the two groups. The degree of change was significantly better in the AA-ML group. AA-ML and IL/ML improve phonatory function, but not to normal. We were unable to demonstrate a statistical difference between groups using a single measure, but using mutlivariate analysis, there is a statistical significance between the groups. AA-ML patients had worse preoperative function and had better postoperative function. When clinically indicated, AA-ML procedure does appear to correct the physiology of the incompetent larynx better than ML alone.