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Using peak direct subglottic pressure level as an objective measure during medialization thyroplasty: a prospective study

  • Laryngology
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Abstract

Type I medialization thyroplasty (MT) was introduced by Isshiki more than 40 years ago. It is one of the most widely used surgical options to correct glottic insufficiency. Intraoperatively, the surgeon relies solely on perceptual subjective measures to help to achieve an optimal glottic closure by bringing the affected vocal fold closer to the midline in order to close the glottic gap. One of the challenges of MT is the persistence of symptoms due to incorrect choice of implant size. As of now, no standard objective measure is being used to determine the optimal implant size needed to achieve the glottic closure required. Peak direct subglottic pressure (PDSGP) is one of the aerodynamic objective measurements of vocal efficiency that significantly increases in cases of glottic insufficiency. It is easily measured during MT by inserting a catheter through the cricothyroid membrane. A prospective study was carried out on patients undergoing MT using the Montgomery Implant®. Choice of implant size was carried out based on the standard perceptual subjective assessment by the operating surgeon and was based on degree of glottic closure and voice quality. PDSGP was recorded for each implant size and then we tested the agreement between the chosen implant size and the lowest PDSGP. The agreement between the implant size of choice and the lowest PDSGP recorded was 62.5 % [CI 44–79 %]. PDSGP was easy to measure and resulted in no complications. PDSGP is a useful tool that could assist in the choice of the correct implant size needed during MT.

Level of evidence: 4.

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Authors and Affiliations

  1. Otolaryngology, Head and Neck Surgery Department, King Saud University, Riyadh, Saudi Arabia

    Moahmmed I. Almohizea

  2. Otolaryngology, Head and Neck Surgery Department, University Hospital of Louvain, Mont-Godinne, 5530, Yvoir, Belgium

    Moahmmed I. Almohizea, Vyas M. N. Prasad, Raja Fakhoury, Benoit Bihin & Marc Remacle

  3. Otolaryngology, Head and Neck Surgery Department, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore

    Vyas M. N. Prasad

  4. Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium

    Benoit Bihin

Authors
  1. Moahmmed I. Almohizea
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  2. Vyas M. N. Prasad
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  3. Raja Fakhoury
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  4. Benoit Bihin
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  5. Marc Remacle
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Correspondence to Moahmmed I. Almohizea.

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No potential conflicts of interest.

All research involving human participants was subject to ethics committee review by the Hospital Ethics Committee and Review Board and deemed to be compliant.

Informed consent was obtained by all patients in the study.

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Almohizea, M.I., Prasad, V.M.N., Fakhoury, R. et al. Using peak direct subglottic pressure level as an objective measure during medialization thyroplasty: a prospective study. Eur Arch Otorhinolaryngol 273, 2607–2611 (2016). https://doi.org/10.1007/s00405-016-4059-5

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  • DOI: https://doi.org/10.1007/s00405-016-4059-5

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