Evaluation of Airway and Voice following Posterior Transverse Cordotomy for Bilateral Vocal Fold Paralysis

Abstract

Objectives: Objectively describe the change in glottic airflow following unilateral transverse posterior cordotomy for bilateral true vocal fold paralysis based on peak inspiratory flow rate and pulmonary function tests. Evaluate the impact of unilateral posterior cordotomy on voice related quality of life. Methods: Retrospective chart review of 17 patients with bilateral vocal fold paralysis undergoing CO2 laser posterior transverse cordotomy from January 2008 through December 2013 in an academic medical center. Preoperative and postoperative pulmonary function tests were reviewed including the peak inspiratory flow rate (PIF) and maximal inspiratory flow at 50% of forced vital capacity (PIF50). The results of the 30-item voice handicap index (Voice Handicap Index), an externally validated survey, were recorded pre- and postprocedure. Results: There was a statistically significant ( P < .0014) improvement in mean peak inspiratory flow rates postprocedure (2.89 L/s) compared with preprocedure (1.57 L/s). There was a 44% improvement in peak inspiratory flow rate following unilateral posterior transverse cordotomy. Expiratory flow loops did not reflect changes in airway following the procedure. There was no statistically significant change ( P < .475) in the voice handicap index scale preoperative and postoperative (55 and 41, scale 0-100). Conclusions: Unilateral posterior transverse cordotomy for bilateral true vocal fold paralysis results in a 44% improvement in peak inspiratory flow rates. Preoperative pulmonary function tests can be used to evaluate the potential success of cordotomy alone for glottis stenosis. This procedure does not result in any statistically significant change in voice related quality of life.