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The surgical treatment of unilateral vocal cord paralysis (UVCP): qualitative review analysis and meta-analysis study

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Abstract

Purpose

The objectives of this meta-analysis were to summarize the key surgical procedures for UVCP and to evaluate which of these is associated with better results in terms of vocal improvement.

Methods

A systematic review of the literature was conducted in search of articles focused on the comparison of voice outcome between different techniques for the UVCP treatment. Then, a quantitative analysis was carried out for papers published from 2013 onwards, reporting only adult patients with unilateral paralysis for each study, and each surgical technique was evaluated for its capability of achieving good functional outcomes in terms of GRBAS-I scale and maximum phonation time in seconds (MPT).

Results

The search identified 1853 publications. A total of 159 articles were stratified and included according to our selection criteria. 21 out of 159 articles were selected for quantitative synthesis. For trans-oral techniques: the mean GRBAS-I scale were 2.33 before injection and 0.41 after injection. The mean MPT before injection were 4.78 and 12.50 after injection. For open techniques the mean GRBAS-I scale were 2.43 before surgery and 0.68 after surgery. For open technique, the mean MPT were 3.50 before surgery and 12.40 after surgery.

Conclusions

The two types of techniques lead to an improvement in terms of vocal outcomes emphasizing that from the examined literature an indication emerges to perform an early injection because this could reduce the possible need for a more invasive intervention of permanent medialization in the future.

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References

  1. Rees CJ, Henderson AH, Belafsky PC (2009) Postviral vagal neuropathy. Ann Otol Rhinol Laryngol 118(4):247–252

    Article  Google Scholar 

  2. Takano S, Nito T, Tamaruya N, Kimura M, Tayama N (2012) Single institutional analysis of trends over 45 years in etiology of vocal fold paralysis. Auris Nasus Larynx 39:597–600

    Article  Google Scholar 

  3. Rosenthal LH, Benninger MS, Deeb RH (2007) Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 117(10):1864–1870

    Article  Google Scholar 

  4. Parnell FW, Brandenburg JH (1970) Vocal cord paralysis. A review of 100 cases. Laryngoscope 80(7):1036–1045

    Article  CAS  Google Scholar 

  5. Terris DJ, Arnstein DP, Nguyen HH (1992) Contemporary evaluation of unilateral vocal cord paralysis. Otolaryngol Head Neck Surg 107(1):84–90

    Article  CAS  Google Scholar 

  6. Cantarella G, Dejonckere P, Galli A et al (2017) A retrospective evaluation of the etiology of unilateral vocal fold paralysis over the last 25 years. Eur Arch Otorhinolaryngol. 274(1):347–353

    Article  Google Scholar 

  7. Francis DO, Pearce EC, Ni S, Gaelyn Garrett C, Penson DF (2014) Epidemiology of vocal fold paralyses after total thyroidectomy for well-differentiated thyroid cancer in a medicare population. Otolaryngol Head Neck Surg 150(4):548–557

    Article  Google Scholar 

  8. Myssiorek D (2004) Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am. 37(1):25–44

    Article  Google Scholar 

  9. Roy N, Merrill RM, Gray SD et al (2005) Voice disorders in the general population: prevalence, risk factors, and occupational impact. Laryngoscope. 115(11):1988–1995

    Article  Google Scholar 

  10. Nouraei SA, Middleton SE, Butler CR et al (2015) An estimation of the population incidence of adult unilateral vocal fold mobility impairment in England. Logoped Phoniatr Vocol. 40(2):93–94

    Article  Google Scholar 

  11. Laccourreye O, Malinvaud D, Ménard M, Bonfils P (2014) Unilateral laryngeal nerve paralysis in the adult: epidemiology, symptoms, physiopathology and treatment. Presse Med. 43(4 Pt 1):348–352

    Article  Google Scholar 

  12. Walton C, Carding P, Flanagan K (2018) Perspectives on voice treatment for unilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg. 26(3):157–161

    Article  Google Scholar 

  13. Rosenthal LHS, Benninger MS, Deeb RH (2007) Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope. 117(10):1864–1870

    Article  Google Scholar 

  14. Jacobson BH, Johnson A, Grywalski C et al (1997) The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol 6:66–70

    Article  Google Scholar 

  15. Rosen CA, Lee AS, Osborne J, Zullo T, Murry T (2004) Development and validation of the voice handicap index-10. Laryngoscope. 114(9):1549–1556

    Article  Google Scholar 

  16. Kempster GB, Gerratt BR, Verdolini Abbott K, Barkmeier-Kraemer J, Hillman RE (2009) Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol. Am J Speech Lang Pathol. 18(2):124–132

    Article  Google Scholar 

  17. Desuter G, Dedry M, Schaar B, van Lith-Bijl J, van Benthem PP, Sjögren EV (2018) Voice outcome indicators for unilateral vocal fold paralysis surgery: a review of the literature. Eur Arch Otorhinolaryngol. 275(2):459–468

    Article  CAS  Google Scholar 

  18. Wang CC, Chang MH, Jiang RS, Lai HC, De Virgilio A, Wang CP, Wu SH, Liu SA, Liang KL (2015) Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis: a prospective long-term follow-up outcome report. JAMA Otolaryngol Head Neck Surg. 141(3):264–271. https://doi.org/10.1001/jamaoto.2014.3466

    Article  PubMed  Google Scholar 

  19. Mohammed H, Masterson L, Gendy S, Nassif R (2016) Outpatient-based injection laryngoplasty for the management of unilateral vocal fold paralysis—clinical outcomes from a UK centre. Clin Otolaryngol. 41(4):341–346. https://doi.org/10.1111/coa.12516

    Article  PubMed  CAS  Google Scholar 

  20. Fang TJ, Pei YC, Hsin LJ, Lin WN, Lee LA, Li HY, Wong AM (2015) Quantitative laryngeal electromyography assessment of cricothyroid function in patients with unilateral vocal fold paralysis. Laryngoscope. 125(11):2530–2535. https://doi.org/10.1002/lary.25418

    Article  PubMed  Google Scholar 

  21. Pei YC, Chuang HF, Chang CF, Chang TL, Chiang HC, Fang TJ (2018) Voice range change after injection laryngoplasty for unilateral vocal fold paralysis. J Voice. 32(5):625–632. https://doi.org/10.1016/j.jvoice.2017.07.019

    Article  PubMed  Google Scholar 

  22. Pei YC, Fang TJ, Hsin LJ, Li HY, Wong AM (2015) Early hyaluronate injection improves quality of life but not neural recovery in unilateral vocal fold paralysis: an open-label randomized controlled study. Restor Neurol Neurosci. 33(2):121–130. https://doi.org/10.3233/RNN-140439

    Article  PubMed  CAS  Google Scholar 

  23. Sielska-Badurek EM, Sobol M, Jędra K, Rzepakowska A, Osuch-Wójcikiewicz E, Niemczyk K (2017) Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis - voice quality outcomes. Wideochir Inne Tech Maloinwazyjne. 12(3):277–284. https://doi.org/10.5114/wiitm.2017.68868

    Article  PubMed  PubMed Central  Google Scholar 

  24. Caffier PP, Nasr AI, Weikert S, Rummich J, Gross M, Nawka T (2017) The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency. Laryngoscope 127(5):1125–1130. https://doi.org/10.1002/lary.26261

    Article  PubMed  CAS  Google Scholar 

  25. Tsou YA, Liu YW, Chang WD, Chen WC, Ke HC, Lin WY, Yang HR, Shie DY, Tsai MH (2016) Using innovative acoustic analysis to predict the postoperative outcomes of unilateral vocal fold paralysis. Biomed Res Int. 2016:7821415

    Article  Google Scholar 

  26. Verma SP, Dailey SH (2014) Office-based injection laryngoplasty for the management of unilateral vocal fold paralysis. J Voice. 28(3):382–386. https://doi.org/10.1016/j.jvoice.2013.10.006

    Article  PubMed  Google Scholar 

  27. Jamal N, Mundi J, Chhetri DK (2014) Higher risk of superficial injection during injection laryngoplasty in women. Am J Otolaryngol. 35(2):159–163

    Article  Google Scholar 

  28. Wen MH, Cheng PW, Liao LJ, Chou HW, Wang CT (2013) Treatment outcomes of injection laryngoplasty using cross-linked porcine collagen and hyaluronic acid. Otolaryngol Head Neck Surg. 149(6):900–906. https://doi.org/10.1177/0194599813508082

    Article  PubMed  Google Scholar 

  29. Lodder WL, Dikkers FG (2015) Comparison of voice outcome after vocal fold augmentation with fat or calcium hydroxylapatite. Laryngoscope. 125(5):1161–1165. https://doi.org/10.1002/lary.25104

    Article  PubMed  CAS  Google Scholar 

  30. Zeleník K, Walderová R, Kučová H, Jančatová D, Komínek P (2017) Comparison of long-term voice outcomes after vocal fold augmentation using autologous fat injection by direct microlaryngoscopy versus office-based calcium hydroxylapatite injection. Eur Arch Otorhinolaryngol. 274(8):3147–3151. https://doi.org/10.1007/s00405-017-4600-1

    Article  PubMed  Google Scholar 

  31. Gotxi-Erezuma I, Ortega-Galán M, Laso-Elguezabal A, Prieto Puga G, Bullido-Alonso C, García-Gutiérrez S, Anton-Ladislao A, Moreno-Alonso E (2017) Electromyography-guided hyaluronic acid injection laryngoplasty in early stage of unilateral vocal fold paralysis. Acta Otorrinolaringol Esp. 68(5):274–283. https://doi.org/10.1016/j.otorri.2016.12.001

    Article  PubMed  Google Scholar 

  32. Pagano R, Morsomme D, Camby S, Lejeune L, Finck C (2017) Long-term results of 18 fat injections in unilateral vocal fold paralysis. J Voice. 31(4):505.e1–505.e9. https://doi.org/10.1016/j.jvoice.2016.10.020

    Article  CAS  Google Scholar 

  33. Elbadan HEM, Hussein WKA, Elmaghraby RM (2017) Transcervical fat injection laryngoplasty for unilateral vocal fold paralysis: an easy way to do the job. Eur Arch Otorhinolaryngol. 274(12):4161–4167. https://doi.org/10.1007/s00405-017-4758-6

    Article  PubMed  Google Scholar 

  34. Lin RJ, Smith LJ, Munin MC, Sridharan S, Rosen CA (2018) Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation. Laryngoscope. 128(7):1628–1633. https://doi.org/10.1002/lary.27078

    Article  PubMed  Google Scholar 

  35. Cantillo-Baños E, Jurado-Ramos A, Gutiérrez-Jódas J, Ariza-Vargas L (2013) Vocal fold insufficiency: medialization laryngoplasty vs calcium hydroxylapatite microspheres (Radiesse Voice®). Acta Otolaryngol. 133(3):270–275. https://doi.org/10.3109/00016489.2012.728717

    Article  PubMed  Google Scholar 

  36. Hamdan AL, Ziade G, Jaffal H, Skaff G (2015) Transnasal injection laryngoplasty. Ann Otol Rhinol Laryngol. 124(6):474–479. https://doi.org/10.1177/0003489414567936

    Article  PubMed  Google Scholar 

  37. McLaughlin CW, Swendseid B, Courey MS, Schneider S, Gartner-Schmidt JL, Yung KC (2018) Long-term outcomes in unilateral vocal fold paralysis patients. Laryngoscope. 128(2):430–436. https://doi.org/10.1002/lary.26900

    Article  PubMed  Google Scholar 

  38. Malik R (2016) Linos, intraoperative neuromonitoring in thyroid surgery: a systematic review. World J Surg. 40(8):2051–2058. https://doi.org/10.1007/s00268-016-3594-y

    Article  PubMed  Google Scholar 

  39. Woo P, Colton R, Casper J, Brewer D (1991) Diagnostic value of stroboscopic examination in hoarse patients. J Voice. 5(3):231–238

    Article  Google Scholar 

  40. Pardo-Maza A, García-Lopez I, Santiago-Pérez S, Gavilán J (2017) Laryngeal electromyography for prognosis of vocal fold paralysis. J Voice. 31(1):90–93. https://doi.org/10.1016/j.jvoice.2016.02.018

    Article  PubMed  Google Scholar 

  41. Foerster G, Mueller AH, Laryngeal EMG (2018) Preferential damage of the posterior cricoarytenoid muscle branches especially in iatrogenic recurrent laryngeal nerve lesions. Laryngoscope. 128(5):1152–1156. https://doi.org/10.1002/lary.26862

    Article  PubMed  Google Scholar 

  42. Sheahan P, O'Connor A, Murphy MS (2012) Risk factors for recurrent laryngeal nerve neuropraxia postthyroidectomy. Otolaryngol Head Neck Surg. 146(6):900–905. https://doi.org/10.1177/0194599812440401

    Article  PubMed  Google Scholar 

  43. Siu J, Tam S, Fung K (2016) A comparison of outcomes in interventions for unilateral vocal fold paralysis: a systematic review. Laryngoscope. 126(7):1616–1624. https://doi.org/10.1002/lary.25739

    Article  PubMed  Google Scholar 

  44. Yung KC, Likhterov I, Courey MS (2011) Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients. Laryngoscope. 121(10):2191–2194. https://doi.org/10.1002/lary.21965

    Article  PubMed  Google Scholar 

  45. Prendes BL, Yung KC, Likhterov I, Schneider SL, Al-Jurf SA, Courey MS (2012) Long-term effects of injection laryngoplasty with a temporary agent on voice quality and vocal fold position. Laryngoscope. 122(10):2227–2233. https://doi.org/10.1002/lary.23473

    Article  PubMed  Google Scholar 

  46. Vila PM, Bhatt NK, Paniello RC (2018) Early-injection laryngoplasty may lower risk of thyroplasty: a systematic review and meta-analysis. Laryngoscope. 128(4):935–940. https://doi.org/10.1002/lary.26894

    Article  PubMed  Google Scholar 

  47. Volk GF, Hagen R, Pototschnig C et al (2012) Laryngeal electromyography: a proposal for guidelines of the European Laryngological Society. Eur Arch Otorhinolaryngol. 269(10):2227–2245. https://doi.org/10.1007/s00405-012-2036-1

    Article  PubMed  Google Scholar 

  48. Mattei A, Desuter G, Roux M, Lee BJ, Louges MA, Osipenko E, Sadoughi B, Schneider-Stickler B, Fanous A, Giovanni A (2018) International consensus (ICON) on basic voice assessment for unilateral vocal fold paralysis. Eur Ann Otorhinolaryngol Head Neck Dis. 135(1S):S11–S15. https://doi.org/10.1016/j.anorl.2017.12.007

    Article  PubMed  CAS  Google Scholar 

  49. DeJonckere PH, Crevier-Buchman L, Marie JP, Moerman M, Remacle M, Woisard V, European Research Group on the Larynx (2003) Implementation of the European Laryngological Society (ELS) basic protocol for assessing voice treatment effect. Rev Laryngol Otol Rhinol (Bord) 124(5):279–283

    CAS  Google Scholar 

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Authors and Affiliations

  1. Otorhinolaryngology Clinic, University of Florence, Florence, Italy

    F. Granato, F. Martelli, L. V. Comini & P. Luparello

  2. Phoniatrics Unit, University Hospital Careggi, Florence, Italy

    S. Coscarelli, O. Le Seac & S. Carucci

  3. Head and Neck and Robotic Surgery, Azienda Ospedaliero Universitaria Careggi, 50141, Florence, Italy

    P. Graziani

  4. Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, CAP 50134, Firenze, Italy

    R. Santoro & Giuditta Mannelli

  5. Department of Statistics Science, University “La Sapienza” of Rome, Rome, Italy

    G. Alderotti

  6. Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy

    M. R. Barillari

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  1. F. Granato
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All persons designated as the authors have participated sufficiently in the work to take public responsibility for the content of the manuscript. All the authors ensure that they all gave substantial contributions: (1) to conception and design or analysis and interpretation of data (2) drafting of the manuscript or revising it for important intellectual content and (3) for final approval of the version to be published, and (4) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Giuditta Mannelli.

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Granato, F., Martelli, F., Comini, L.V. et al. The surgical treatment of unilateral vocal cord paralysis (UVCP): qualitative review analysis and meta-analysis study. Eur Arch Otorhinolaryngol 276, 2649–2659 (2019). https://doi.org/10.1007/s00405-019-05587-2

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