Initial investigation of anterior approach to arytenoid adduction in excised larynges

Abstract

Arytenoid adduction (AA) can dramatically improve voice quality in patients with vocal fold paralysis (VFP); however, it is technically challenging. We present an anterior approach to AA, where GORE-TEX suture attached to curled wire is passed through the thyroid cartilage or cricothyroid membrane via a guide needle and used to manipulate the muscular process of the arytenoid. Performing AA via an anterior approach leads to comparable aerodynamic and acoustic outcomes compared to traditional AA in an excised larynx model. Repeated measures with each larynx serving as its own control. We performed thyroplasty followed by traditional and anterior AA on excised larynges with simulated VFP. Aerodynamic and acoustic measurements were recorded. Anterior AA significantly improved aerodynamic (phonation threshold power: P = .003) and acoustic parameters (percentage jitter: P = .028; percentage shimmer: P = .001; signal-to-noise ratio: P = .034) compared to VFP in this excised larynx model. Anterior AA and traditional AA produced comparable improvements in all parameters (phonation threshold power: P = .256; percentage jitter: P = .616; percentage shimmer: P = .281; signal-to-noise ratio: P = .970). Anterior AA is an alternative to traditional AA that is easier to perform and produces comparable improvements in laryngeal function.