Skip to main content
SpringerLink
Log in

Long-term voice outcomes of laryngeal framework surgery for unilateral vocal fold paralysis

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the short- and long-term voice outcomes after unilateral medialization thyroplasty (MT) and unilateral medialization thyroplasty with arytenoid adduction (MT + AA) in patients with unilateral vocal fold paralysis.

Methods

Voice outcomes were assessed preoperatively, and postoperatively at 3 and 12 months according to a standardized protocol. Voice assessment was performed using Voice Handicap Index (VHI), GRBAS Grade, Maximum Phonation Time (MPT), s/z-ratio and subjective numeric rating scales on voice quality, effort, performance and influence on life.

Results

Sixty-one patients were included (34 MT and 27 MT + AA). Significant pre- to postoperative improvements were seen in all voice outcome parameters. No significant differences in post-operative values were identified between the groups.

Conclusion

Based on our findings, we conclude that patients with unilateral vocal fold paralysis who undergo MT and MT + AA achieve comparable and significant long time voice improvement, although voices do not completely normalize. We also conclude that this does not mean that AA is a superfluous procedure, but can indicate the accurate identification of patients in need of the additional AA procedure based on clinical parameters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Data available on reasonable request via corresponding author.

Code availability

Not applicable.

References

  1. Rubin J, Sataloff RKG (2014) Diagnosis and Treatment of Voice Disorders

  2. Misono S, Merati AL (2012) Evidence-based practice: evaluation and management of unilateral vocal fold paralysis. Otolaryngol Clin North Am 45:1083–1108. https://doi.org/10.1016/j.otc.2012.06.011

    Article  PubMed  Google Scholar 

  3. Desuter G, Zapater E, Van der Vorst S et al (2018) Very long-term voice handicap index voice outcomes after montgomery thyroplasty: a cross-sectional study. Clin Otolaryngol 43:1097–1103. https://doi.org/10.1111/coa.13113

    Article  CAS  PubMed  Google Scholar 

  4. Woo P (2000) Arytenoid adduction and medialization laryngoplasty. Otolaryngol Clin North Am 33:817–840

    Article  CAS  PubMed  Google Scholar 

  5. Isshiki N, Tanabe M, Sawada M (1978) Arytenoid adduction for unilateral vocal cord paralysis. Arch Otolaryngol 104:555–558. https://doi.org/10.1001/archotol.1978.00790100009002

    Article  CAS  PubMed  Google Scholar 

  6. Parker NP, Barbu AM, Hillman RE et al (2015) Revision transcervical medialization laryngoplasty for unilateral vocal fold paralysis. Otolaryngol Head Neck Surg (United States) 153:593–598. https://doi.org/10.1177/0194599815585091

    Article  Google Scholar 

  7. Lundy DS, Casiano RR, Xue JW (2004) Can maximum phonation time predict voice outcome after thyroplasty type I? Laryngoscope 114:1447–1454. https://doi.org/10.1097/00005537-200408000-00025

    Article  PubMed  Google Scholar 

  8. Ryu IS, Nam SY, Han MW et al (2012) Long-term voice outcomes after thyroplasty for unilateral vocal fold paralysis. Arch Otolaryngol Head Neck Surg 138:347–351. https://doi.org/10.1001/archoto.2012.42

    Article  PubMed  Google Scholar 

  9. Benninger MS, Manzoor N, Ruda JM (2015) Short- and long-term outcomes after silastic medicalization laryngoplasty: are arytenoid procedures needed? J Voice 29:236–240. https://doi.org/10.1016/j.jvoice.2014.07.008

    Article  PubMed  Google Scholar 

  10. Kwak PE, Tritter AG, Donovan DT, Ongkasuwan J (2016) Long-term voice outcomes of early thyroplasty for unilateral vocal fold paralysis following aortic arch surgery. Ann Otol Rhinol Laryngol 125:559–563. https://doi.org/10.1177/0003489416636127

    Article  PubMed  Google Scholar 

  11. Chester MW, Stewart MG (2003) Arytenoid adduction combined with medialization thyroplasty: an evidence-based review. Otolaryngol Neck Surg Off J Am Acad Otolaryngol Neck Surg 129:305–310. https://doi.org/10.1016/s0194-5998(03)01390-1

    Article  Google Scholar 

  12. McCulloch TM, Hoffman HT, Andrews BT, Karnell MP (2000) Arytenoid adduction combined with Gore-Tex medialization thyroplasty. Laryngoscope 110:1306–1311. https://doi.org/10.1097/00005537-200008000-00015

    Article  CAS  PubMed  Google Scholar 

  13. Mortensen M, Carroll L, Woo P (2009) Arytenoid adduction with medialization laryngoplasty versus injection or medialization laryngoplasty: the role of the arytenoidopexy. Laryngoscope 119:827–831. https://doi.org/10.1002/lary.20171

    Article  PubMed  Google Scholar 

  14. Konomi U, Watanabe Y, Komazawa D (2016) Sex differences in pitch range and speech fundamental frequency after arytenoid adduction and thyroplasty. J Voice 30:362–370. https://doi.org/10.1016/j.jvoice.2015.03.011

    Article  PubMed  Google Scholar 

  15. Chang J, Schneider SL, Curtis J et al (2017) Outcomes of medialization laryngoplasty with and without arytenoid adduction. Laryngoscope 127:2591–2595. https://doi.org/10.1002/lary.26773

    Article  PubMed  Google Scholar 

  16. Abraham MT, Gonen M, Kraus DH (2001) Complications of type I thyroplasty and arytenoid adduction. Laryngoscope 111:1322–1329. https://doi.org/10.1097/00005537-200108000-00003

    Article  CAS  PubMed  Google Scholar 

  17. Tokashiki R, Hiramatsu H, Shinada E et al (2012) Analysis of pitch range after arytenoid adduction by fenestration approach combined with type i thyroplasty for unilateral vocal fold paralysis. J Voice 26:792–796. https://doi.org/10.1016/j.jvoice.2011.11.012

    Article  PubMed  Google Scholar 

  18. Billante CR, Clary J, Childs P, Netterville JL (2002) Voice gains following thyroplasty may improve over time. Clin Otolaryngol Allied Sci 27:89–94. https://doi.org/10.1046/j.1365-2273.2002.00536.x

    Article  CAS  PubMed  Google Scholar 

  19. Spector BC, Netterville JL, Billante C et al (2001) Quality-of-life assessment in patients with unilateral vocal cord paralysis. Otolaryngol Head Neck Surg 125:176–182. https://doi.org/10.1067/mhn.2001.117714

    Article  CAS  PubMed  Google Scholar 

  20. Morgan JE, Zraick RI, Griffin AW et al (2007) Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis. Laryngoscope 117:2068–2074. https://doi.org/10.1097/MLG.0b013e318137385e

    Article  PubMed  Google Scholar 

  21. McLaughlin CW, Swendseid B, Courey MS et al (2018) Long-term outcomes in unilateral vocal fold paralysis patients. Laryngoscope 128:430–436. https://doi.org/10.1002/lary.26900

    Article  PubMed  Google Scholar 

  22. Li AJ, Johns MM, Jackson-Menaldi C et al (2011) Glottic closure patterns: type I thyroplasty versus type I thyroplasty with arytenoid adduction. J Voice 25:259–264. https://doi.org/10.1016/j.jvoice.2009.11.001

    Article  PubMed  Google Scholar 

  23. Sulica L (2008) The natural history of idiopathic unilateral vocal fold paralysis: evidence and problems. Laryngoscope 118:1303–1307. https://doi.org/10.1097/MLG.0b013e31816f27ee

    Article  PubMed  Google Scholar 

  24. Kaplan MH, Feinstein AR (1974) The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis 27:387–404. https://doi.org/10.1016/0021-9681(74)90017-4

    Article  CAS  PubMed  Google Scholar 

  25. Jacobson BH, Johnson A, Grywalski C et al (1997) the voice handicap index (VHI) development and validation. Am J Speech-Language Pathol 6:66–70. https://doi.org/10.1044/1058-0360.0603.66

    Article  Google Scholar 

  26. Hakkesteegt MM, Wieringa MH, Gerritsma EJ, Feenstra L (2006) Reproducibility of the dutch version of the voice handicap index. Folia Phoniatr Logop 58:132–138. https://doi.org/10.1159/000089613

    Article  PubMed  Google Scholar 

  27. Webb AL, Carding PN, Deary IJ et al (2004) The reliability of three perceptual evaluation scales for dysphonia. Eur Arch Oto-Rhino-Laryngology 261:429–434. https://doi.org/10.1007/s00405-003-0707-7

    Article  CAS  Google Scholar 

  28. Hirano M (1981) Clinical examination of voice. Springer Verlag

    Google Scholar 

  29. Little MA, Costello DAE, Harries ML (2011) Objective dysphonia quantification in vocal fold paralysis: comparing nonlinear with classical measures. J Voice 25:21–31. https://doi.org/10.1016/j.jvoice.2009.04.004

    Article  PubMed  Google Scholar 

  30. Eckel FC, Boone DR (1981) The S/Z ratio as an indicator of laryngeal pathology. J Speech Hear Disord 46:147–149. https://doi.org/10.1044/jshd.4602.147

    Article  CAS  PubMed  Google Scholar 

  31. Isshiki N, Okamura H, Ishikawa T (1975) Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy. Acta Otolaryngol 80:465–473. https://doi.org/10.3109/00016487509121353

    Article  CAS  PubMed  Google Scholar 

  32. Maragos NE (1998) The type I thyroplasty window: Implications of normal thyroid cartilage thickness. J Voice 12:107–111. https://doi.org/10.1016/S0892-1997(98)80082-9

    Article  CAS  PubMed  Google Scholar 

  33. Beunckens C, Molenberghs G, Kenward MG (2005) Direct likelihood analysis versus simple forms of imputation for missing data in randomized clinical trials. Clin Trials 2:379–386. https://doi.org/10.1191/1740774505cn119oa

    Article  PubMed  Google Scholar 

  34. Rosenthal LHS, Benninger MS, Deeb RH (2007) vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 117:1864–1870. https://doi.org/10.1097/MLG.0b013e3180de4d49

    Article  PubMed  Google Scholar 

  35. Mattei A, Desuter G, Roux M et al (2018) International consensus (ICON) on basic voice assessment for unilateral vocal fold paralysis. Eur Ann Otorhinolaryngol Head Neck Dis 135:S11-s15. https://doi.org/10.1016/j.anorl.2017.12.007

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  37. Lu FL, Casiano RR, Lundy DS, Xue JW (1996) Longitudinal evaluation of vocal function after thyroplasty type I in the treatment of unilateral vocal paralysis. Laryngoscope 106:573–577. https://doi.org/10.1097/00005537-199605000-00010

    Article  CAS  PubMed  Google Scholar 

  38. Lundy DS, Casiano RR, Xue JW, Lu FL (2000) Thyroplasty type I: short- versus long-term results. Otolaryngol Head Neck Surg 122:533–536. https://doi.org/10.1067/mhn.2000.102186

    Article  CAS  PubMed  Google Scholar 

  39. Netterville JL, Stone RE, Luken ES et al (1993) Silastic medialization and arytenoid adduction: the vanderbilt experience. a review of 116 phonosurgical procedures. Ann Otol Rhinol Laryngol 102:413–424. https://doi.org/10.1177/000348949310200602

    Article  CAS  PubMed  Google Scholar 

  40. Zimmermann TM, Orbelo DM, Pittelko RL et al (2019) Voice outcomes following medialization laryngoplasty with and without arytenoid adduction. Laryngoscope 129:1876–1881. https://doi.org/10.1002/lary.27684

    Article  CAS  PubMed  Google Scholar 

  41. Miller FR, Bryant GL, Netterville JL (1999) Arytenoid adduction in vocal fold paralysis. Oper Tech Otolaryngol Neck Surg 10:36–41. https://doi.org/10.1016/S1043-1810(99)80047-5

    Article  Google Scholar 

  42. Van Gogh CDL, Mahieu HF, Kuik DJ et al (2007) Voice in early glottic cancer compared to benign voice pathology. Eur Arch Oto-Rhino-Laryngol 264:1033–1038. https://doi.org/10.1007/s00405-007-0313-1

    Article  Google Scholar 

  43. Sano D, Matsushima K, Isono Y et al (2020) Long-term treatment outcome of type 1 thyroplasty using novel titanium medialization laryngoplasty implant combined with arytenoid adduction for unilateral vocal cord paralysis: single-arm interventional study at a single institution. Laryngoscope Investig Otolaryngol 5:895–902. https://doi.org/10.1002/lio2.462

    Article  PubMed  PubMed Central  Google Scholar 

  44. Labaere A, Ceuppens P (2015) Presentation VVL Congress 2015 VHI-10. https://www.vvl.be/documenten-en-paginas/36ste-vvl-congres-documenten/36ste-vvl-congres-free-papers?download=Sessie10Voordracht2LabaereenCeuppens.pdf1–22

  45. Suehiro A, Hirano S, Kishimoto Y et al (2009) Comparative study of vocal outcomes with silicone versus Gore-Tex thyroplasty. Ann Otol Rhinol Laryngol 118:405–408. https://doi.org/10.1177/000348940911800602

    Article  PubMed  Google Scholar 

  46. Song SA, Santeerapharp A, Choksawad K, Franco RA Jr (2021) Revisions and complications with Gore-Tex medialisation laryngoplasty: a 19-year experience. Clin Otolaryngol. https://doi.org/10.1111/coa.13739

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Mrs. V.A.H. van de Kamp for her assistance in collecting voice data and voice evaluation.

Funding

None of the authors received any funding to conduct this study.

Author information

Authors and Affiliations

  1. Department of ENT, Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands

    Stephanie D. Mes, Martine Hendriksma, Bas J. Heijnen, Jeroen C. Jansen, Antonius P. M. Langeveld & Elisabeth V. Sjögren

  2. Department of Transplant Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Ben F. J. Goudsmit

Authors
  1. Stephanie D. Mes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martine Hendriksma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bas J. Heijnen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ben F. J. Goudsmit
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeroen C. Jansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonius P. M. Langeveld
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elisabeth V. Sjögren
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: SM, BH, AL and EV; data collection: SM, BG; analysis: SM, MH; interpretation and implications of results: SM, MH, EV, BH; drafting manuscript: SM and EV; critical revision of the manuscript and final approval: all authors.

Corresponding author

Correspondence to Stephanie D. Mes.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Ethics approval

The study was approved by the local medical ethical committee code G17.118.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mes, S.D., Hendriksma, M., Heijnen, B.J. et al. Long-term voice outcomes of laryngeal framework surgery for unilateral vocal fold paralysis. Eur Arch Otorhinolaryngol 279, 1957–1965 (2022). https://doi.org/10.1007/s00405-021-07177-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-021-07177-7

Keywords

Search

Navigation