Comparison of Voice Outcomes between Medialization Thyroplasty and Arytenoid Adduction with or without Injection Laryngoplasty in Unilateral Vocal Fold Paralysis Patients

Abstract

Background and Objectives In unilateral vocal fold paralysis (VFP), medialization thyroplasty (MT), arytenoid adduction (AA) and injection layrngoplasty (IL) are the most common procedures to correct phonatory problems. There is no consensus that which procedure is superior to the other for correcting the glottal insufficiency. The purpose of this study was to compare the phonatory parameters between MT, AA and AA with IL (AA+IL) in patients with unilateral VFP. Materials and Methods This retrospective study enrolled patients from 2005 to 2016. Total 72 patients (49 male, 23 female, mean age 54.5 years) were classified into three groups ; MT (n=28), AA (n=12), and AA+IL (n=32). GRBAS scales, maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), and voice handicap index (VHI)-10 and VHI-30 were preoperatively and postoperatively collected and compared between the three groups. Results Age, gender and cause of VFP were not significantly different between the three groups. In MT and AA groups, MPT, VHI, G (overall grade) and B (breathiness) were significantly improved. In AA+IL group, jitter, shimmer, NHR, MPT, VHI, G and B were significantly improved. In analysis of differences (pre-postoperative values), Δ jitter (p＜0.001), Δ shimmer (p=0.031), and Δ NHR (p=0.002) were significantly different and AA+IL group showed the greatest improvement. Conclusion Analysis of voice parameters showed that all the three procedures for patients with unilateral VFP are effective in the improvement of voice ; especially in MPT, VHI-10, G and B scales. Compared to the others, AA+IL provided the better acoustic values including jitter, shimmer and NHR. Key words: Medialization thyroplasty ㆍ Arytenoid adduction ㆍ Injection laryngoplasty ㆍ Unilateral vocal fold paralysis ㆍ Voice parameters 핵심용어: ë‚´ì „í˜• ê°‘ìƒì„±í˜•ìˆ ã† í”¼ì—´ì—°ê³¨ë‚´ì „ìˆ ã† í›„ë‘ì£¼ìž ìˆ ìŒì„± 지표