Abstract
PurposeTo evaluate voice outcome after bilateral medialization thyroplasty in patients with non-paralytic glottic insufficiency due to vocal fold atrophy with or without sulcus.MethodsRetrospective cohort study on 29 patients undergoing bilateral medialization thyroplasty for vocal fold atrophy (14 procedures) or atrophy with sulcus (15 procedures) between October 2012 and November 2017. Voice data were collected and analyzed for the preoperative and the 3- and 12-month postoperative time point according to a standardized protocol, including Voice Handicap Index (VHI)-30 and perceptual, acoustic and aerodynamic parameters. Failure rate was based on number of revisions within 12 months and non-relevant improvement (< 10 points) in VHI-30 at 12 months.ResultsThere was a clinically relevant (≥ 15 points) and statistically significant improvement (p < 0.0001) in the VHI-30 (preoperative: 55.8 points; postoperative at 12 months: 30.9 points). Fundamental frequency for male subjects decreased significantly from 175 to 159 Hz (p = 0.0001). The pre- and post-operative grade of dysphonia was significantly lower in patients with atrophy compared to atrophy and sulcus (mean difference 0.70, p = 0.017).ConclusionBilateral medialization thyroplasty is a valid treatment option for patients with atrophy with or without sulcus. Outcomes are comparable to other methods reported in literature. However, there is a great need for larger, prospective studies with long-term follow-up to gain more insight into the comparative voice outcomes for the different forms of surgery for patients with glottic incompetence due to atrophy with or without sulcus.
Highlights
Non-paralytic glottic insufficiency is a common cause of dysphonia affecting both voice quality as vocal function and causing substantial patient’s burden
We evaluated the results after bilateral medialization thyroplasty in patients with vocal fold atrophy with or without sulcus
At baseline the pre-operative values of the different voice parameters were comparable between the patient groups except for grade of dysphonia
Summary
Non-paralytic glottic insufficiency is a common cause of dysphonia affecting both voice quality as vocal function and causing substantial patient’s burden. The main surgical treatment for atrophy is vocal fold medialization. For the treatment of atrophy associated with sulcus epithelium freeing techniques can be used as an alternative or in addition to medialization [5]. At this moment there is no evidence-based decision algorithm available to identify the optimal treatment for an individual patient with sulcus [6]. In their consensus report, the European Laryngological Society (ELS)
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